Quality Analyst IV – Clinical Validation Auditor, Healthcare

EXL

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

Posted 10/13/2026full-timeRemote • United StatesMid-LevelSenior💰 $85,000 - $110,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in DRG audits and clinical validation, with a strong focus on accuracy, compliance, and mentoring. Possesses excellent communication and organizational skills to effectively lead teams and improve auditing processes.

Highest-signal resume keywords

Registered Nurse LicenseClinical Validation AuditsAuditing and Monitoring SkillsMedical TerminologyDecision Making Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

DRG AuditsClinical JudgmentRoot Cause AnalysisProcess ImprovementTechnical Knowledge

Soft Skills

MentoringCommunication SkillsOrganizational SkillsInterpersonal SkillsFlexibility

Tools & Technologies

Personal Computer Skills

Certifications & Qualifications

Registered Nurse License

Industry Keywords

ComplianceInformation SecurityRegulatory PoliciesHuman PhysiologyClinical Auditing

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' work and ensure audits are appropriately marked for findings and no findings
Mentor Clinical DRG auditors
Recommend process changes to improve quality and performance
Communicate with peers and management
Provide root cause analysis on errors
Perform other duties as assigned
Conduct responsibilities in accordance with company Compliance, Information Security and Regulatory policies, procedures and programs

Requirements

What you’ll need

Current Registered Nurse license
5 plus years experience working with clinical validation audits
Superior auditing and monitoring skills
Ability to mentor and instruct
Excellent decision making skills and sound judgment
Thorough understanding of medical terminology and human physiology
Strong technical knowledge and ability to learn new systems quickly
Excellent oral/presentation and written communication skills
Ability to complete tasks efficiently and resolve problems within set timelines
Strong organizational skills and attention to detail
Ability to work in a team environment and independently as needed
Demonstrated flexibility and adaptability
Must be able to work under deadlines and utilize independent decision-making skills
High degree of accuracy in varied responsibilities
Personal computer skills required
Self-motivated to complete work timely and meet deadlines
Strong interpersonal skills required

Benefits

Comp & perks

Benefits information available at https://www.exlservice.com/us-careers-and-benefits