Senior Clinical Auditor

EXL

. Review and audit medical claims against patient medical records to ensure accuracy and completeness of documentation .

Posted 9/23/2026full-timeChennai • IndiaSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in auditing medical claims and ensuring compliance with CMS guidelines and payer policies. Possesses strong clinical knowledge and communication skills to effectively collaborate with healthcare teams and support accurate claim submissions.

Highest-signal resume keywords

Bachelor's Degree In NursingActive State Nursing CertificationClinical/Hospital ExperienceAuditing ExperienceKnowledge Of US Healthcare System

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Claims ReviewClinical Documentation AuditingCompliance MonitoringQuality Assurance ReviewsError Analysis

Soft Skills

Strong Written CommunicationOral Communication SkillsCollaboration

Tools & Technologies

Audit Reporting ToolsProductivity Logs

Certifications & Qualifications

Active State Nursing Certification

Industry Keywords

CMS GuidelinesPayer PoliciesClinical GuidelinesMedical TerminologyCare Management

About the role

Key responsibilities & impact

Review and audit medical claims against patient medical records to ensure accuracy and completeness of documentation
Identify discrepancies between clinical documentation and billed services, highlighting variances and potential billing errors
Perform detailed clinical reviews to validate diagnosis, procedures, and level of care in accordance with industry standards
Ensure compliance with CMS guidelines, payer policies, and regulatory requirements during claim review processes
Conduct best practice audits to identify documentation gaps, coding inaccuracies, and revenue leakage opportunities
Provide structured findings and audit reports with clear recommendations for corrective action and process improvement
Collaborate with coding, billing, and provider teams to resolve audit findings and support accurate claim submissions
Monitor trends in audit results and identify recurring issues requiring targeted education or intervention
Support quality assurance initiatives by maintaining audit accuracy benchmarks and meeting productivity standards
Participate in continuous improvement activities, including updates on CMS regulations, clinical guidelines, and payer policy changes
Perform audit based on clinical knowledge while reviewing the medical record
Perform quality assurance reviews to assess comprehension of training efforts
Ensure to view all documented system information and additional records/data supporting a determination or recommendation
Condense clinical information into a clear and precise clinical picture while taking a final decision
Analyze errors and approach the quality team for clarification when required
Complete audits with quality and achieve expected quality and production targets
Follow project-related protocols, SOPs, and instructions
Update productivity, clarification, and other applicable logs daily
Align with Manager/TL on program delivery
Respond to emails promptly
Ensure compliance of the entire team

Requirements

What you’ll need

Bachelor’s degree in nursing
Active State Nursing certification is Mandatory
Minimum 3 years of clinical/hospital experience is mandatory
Auditing experience (Optional)
Strong written (documentation) and oral communication skills
Familiarity with basic medical terminology and concepts used in care management
Should have a good understanding of US healthcare system and management
High Speed internet connection at home, must be broadband
Must understand and adhere with telecommuter policy

Benefits

Comp & perks

40 hours per week as Full-time employee
Shift time: 08:00 AM TO 05:00 PM IST (It might be changed based on project requirements)
Weekends: Off
High Speed internet connection at home, must be broadband
Must understand and adhere with telecommuter policy