[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.

Responsibilities

• 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

Skills

• 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

Benefits

• Fully remote position
• We’ll train you if needed!
• Flexibility of remote work
• A culture of support
• The opportunity to grow in the fast-evolving world of healthcare analytics

Company Overview