Senior Clinical Auditor

EXL

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

Posted 10/14/2026full-timeChennai • IndiaSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in reviewing and auditing medical claims against patient records, ensuring compliance with CMS guidelines and payer policies. Proficient in identifying discrepancies, conducting clinical reviews, and providing actionable recommendations for process improvement.

Highest-signal resume keywords

Bachelor's Degree In NursingActive State Nursing CertificationClinical/Hospital ExperienceStrong Written And Oral Communication SkillsUnderstanding Of US Healthcare System

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Claims ReviewClinical Documentation AuditingDiagnosis ValidationCoding Accuracy AssessmentRegulatory ComplianceQuality Assurance ReviewsAudit ReportingDocumentation Gap IdentificationTrend MonitoringProcess Improvement

Soft Skills

CollaborationAttention To DetailProblem SolvingEffective CommunicationTime Management

Certifications & Qualifications

Active State Nursing Certification

Industry Keywords

CMS GuidelinesPayer PoliciesHealthcare ComplianceMedical TerminologyCare ManagementAudit StandardsRevenue LeakageContinuous ImprovementTelecommuter PolicySOPs

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 quality assurance reviews and ensure audit accuracy and productivity targets
Update productivity, clarification, and other applicable logs daily
Align with Manager/TL on program delivery and respond promptly to emails
Follow SOPs, project protocols, and process changes

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
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
Must understand and adhere with telecommuter policy
Auditing experience (Optional)

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