[Remote] Clinical Validation Auditor III

Note: The job is a remote job and is open to candidates in USA. EXL is a company that values collaboration and clinical accuracy, and they are seeking a Clinical Validation Auditor to ensure medical claims are coded accurately. In this fully remote role, you will review inpatient medical records, validate DRG codes, and identify overpayments using your clinical expertise.ResponsibilitiesReview inpatient medical records to verify that the DRG (Diagnosis-Related Group) code makes sense based on the documentationApply clinical and coding knowledge to spot inaccuracies and identify potential overpaymentsDocument your findings in clear, professional language that explains the rationale behind your reviewUse industry tools like 3M or Webstrat (don’t worry—we’ll train you if needed!) to support your decisionsWork independently while meeting productivity and quality goalsStay up to date with clinical guidelines, DRG rules, and industry trendsSkillsRegistered Nurse (RN) with an active license5+ years of acute care experience (hospital setting preferred)Experience in DRG audits or coding validation is a big plus!Bonus points if you have certifications like CCS, RHIA, or RHITKnowledge of readmission reviews (PPR) is also a plusBenefitsFully remote positionWe’ll train you if needed!Flexibility of remote workA culture of supportThe opportunity to grow in the fast-evolving world of healthcare analyticsCompany OverviewEXL is a provider of Transformation and Outsourcing services to Global 1000 companies in multiple industries It was founded in 1999, and is headquartered in New York, New York, USA, with a workforce of 10001+ employees. Its website is http://www.exlservice.com.