Clinical Validation Auditor (CVA) Auditor III
About the Role
Now Hiring: Clinical Validation Auditor (Fully Remote in US). Use your clinical expertise to make a real impact – all from the comfort of your home!
Full Job Posting
Qualifications
- What We’re Looking For:
- Registered Nurse (RN) with an active license.
- 5+ 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 RHIT
- Knowledge of readmission reviews (PPR) is also a plus
- You’ll Be a Great Fit If You:
- Love digging into the details and solving problems
- Know how to explain clinical decisions clearly and professionally
- Can manage your time well and stay focused working remotely
- Are comfortable using tools like Excel, Word, and OneNote
- Enjoy working as part of a supportive, high-performing team
- Why Work at EXL?
- At EXL, you’ll join a team that values collaboration, clinical accuracy, and continuous improvement. We offer the flexibility of remote work, a culture of support, and the opportunity to grow in the fast-evolving world of healthcare analytics.
- Ready to take the next step in your clinical career? Apply today and make a difference with EXL!
- For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
- The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.
Responsibilities
- What You’ll Be Doing:
- Review inpatient medical records to verify that the DRG (Diagnosis-Related Group) code makes sense based on the documentation.
- Apply clinical and coding knowledge to spot inaccuracies and identify potential overpayments.
- Document your findings in clear, professional language that explains the rationale behind your review.
- Use industry tools like 3M or Webstrat (don’t worry—we’ll train you if needed!) to support your decisions.
- Work independently while meeting productivity and quality goals.
- Stay up to date with clinical guidelines, DRG rules, and industry trends.
Preferred Qualifications
- 5+ years of acute care experience (hospital setting preferred)
- Bonus points if you have certifications like CCS, RHIA, or RHIT
- Knowledge of readmission reviews (PPR) is also a plus
About EXL
EXL is a global data and AI company that provides analytics, digital operations, and industry-specific services to enterprises in insurance, healthcare, banking, retail, media, and energy.
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