Quality Analyst – Clinical Validation Audit

EXL

. Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding .

Posted 9/29/2026full-timeRemote • United StatesMid-LevelSenior💰 $85,000 - $100,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in DRG auditing, including clinical judgment, root cause analysis, and mentoring of auditors. Proficient in using DRG encoder tools and maintaining compliance with regulatory standards while ensuring accuracy in coding and documentation.

Highest-signal resume keywords

DRG AuditingClinical JudgmentRoot Cause AnalysisMentoringDRG Encoder Tools

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Acute Care Nursing ExperienceClinical Criteria DocumentationAuditing SkillsCoding ValidationDRG Retrospective Overpayment IdentificationReadmission AuditingExcel ProficiencyWord ProficiencyOneNote ProficiencyGeneral Computer Literacy

Soft Skills

Time ManagementWork PrioritizationProblem-SolvingAttention to DetailCommunication Skills

Tools & Technologies

Solventum/3MTruBridgeWebstratEXL Proprietary Tools

Certifications & Qualifications

Registered NurseCCSRHIARHIT

Industry Keywords

DRG CodingComplianceInformation SecurityRegulatory PoliciesAudit Trends

About the role

Key responsibilities & impact

Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding
Review the accuracy and consistency of clinical DRG auditors
Ensure audits are appropriately marked for findings and no findings
Mentor Clinical DRG auditors
Identify audit trends and referrals for DRG coding review
Provide root cause analysis on errors
Use industry and EXL proprietary tools in the DRG assignment process
Write professional communications documenting audit findings and supporting rationales
Recommend process changes to improve quality and performance
Communicate with peers and management
Perform other duties as assigned
Follow company Compliance, Information Security, and Regulatory policies, procedures, and programs

Requirements

What you’ll need

Registered Nurse, Associate's or Bachelor's degree
5+ years of acute care nursing experience
Preference for prior clinical or coding validation audit experience
Preferred prior DRG retrospective overpayment identification auditing experience
Preferred prior readmission (PPR) auditing experience
Preference for CCS, RHIA, or RHIT coding credentials
Superior auditing and monitoring skills
Ability to mentor
Extensive knowledge of clinical criteria documentation requirements used to substantiate code assignments
Experience with DRG encoder tools (Solventum/3M, TruBridge, Webstrat)
Ability to work independently in a remote environment during EXL core business hours
Excellent time management and work prioritization skills
Problem-solving ability and ownership
Excellent written and verbal communication skills
Strong analytical skills and attention to detail
Proficiency in Excel, Word, and OneNote with general computer literacy
Passion for DRG auditing and teamwork, excellence, and collaboration

Benefits

Comp & perks

Up to 10% annual travel for team meetings and limited client onsite engagements
Exciting, fast paced, and innovative environment
Opportunity to work closely with highly experienced, world class Healthcare consultants
Opportunities to learn multiple aspects of clients’ businesses
Teamwork and time-management skill development
Guidance/coaching through a mentoring program
Senior-level professional advisor assigned to every junior-level employee
Further growth and development opportunities