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EXL
EXL
Skilled Worker Visa SponsorHealthcareInsuranceLogistics
EXL is a business consulting and services company that helps organizations use data, analytics, and technology to improve operations and make better decisions. Its work includes operations management, decision analytics, and digital transformation, with experience supporting clients in healthcare, insurance, finance, and logistics. EXL combines data science with practical business expertise to develop solutions tailored to each organization’s goals, operating model, and industry context.
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Quality Analyst, Clinical Validation Audit – United States Remote

EXL is seeking a quality analyst to review inpatient DRG audits for clinical validation accuracy. The role includes mentoring auditors, investigating errors, and strengthening coding quality.

USUnited States
$85,000 – $100,000 / year
RemoteFull-timeMiddleSeniorEnglish RequiredAnalyst

Description

  • Apply clinical judgment to inpatient DRG audits and verify coding accuracy.
  • Assess clinical DRG auditors for accuracy and consistency.
  • Confirm that audits are correctly classified as findings or no findings.
  • Coach and mentor clinical DRG auditors.
  • Track audit trends and identify cases requiring DRG coding review.
  • Perform root cause analysis of audit errors.
  • Use industry-standard and EXL proprietary tools during DRG assignment.
  • Prepare clear professional communications documenting findings and supporting rationales.
  • Recommend process improvements that enhance quality and performance.
  • Collaborate with peers and management.
  • Handle additional duties as assigned.
  • Comply with company policies and programs covering compliance, information security, and regulatory requirements.

Requirements

  • Registered Nurse license or an associate's or bachelor's degree.
  • At least five years of acute care nursing experience.
  • Clinical or coding validation audit experience is preferred.
  • Experience auditing retrospective DRG overpayment identification is preferred.
  • Experience auditing readmissions, including PPRs, is preferred.
  • CCS, RHIA, or RHIT coding credentials are preferred.
  • Demonstrated strength in auditing and monitoring.
  • Ability to mentor colleagues.
  • Extensive understanding of clinical criteria and documentation requirements supporting code assignments.
  • Experience using DRG encoder tools such as Solventum/3M, TruBridge, or Webstrat.
  • Ability to work independently in a remote setting during EXL core business hours.
  • Strong time management and prioritization skills.
  • Sound problem-solving judgment and accountability for outcomes.
  • Excellent written and verbal communication skills.
  • Strong analytical ability and close attention to detail.
  • Proficiency with Excel, Word, and OneNote, along with general computer literacy.
  • Interest in DRG auditing and a collaborative commitment to teamwork and excellence.

Benefits

  • Up to 10% annual travel may be required for team meetings and limited client onsite engagements.
  • Work in a fast-paced, innovative environment.
  • Collaborate with experienced healthcare consultants.
  • Gain exposure to multiple areas of clients' businesses.
  • Develop teamwork and time-management skills.
  • Receive guidance and coaching through a mentoring program.
  • Access a senior professional advisor through the program for junior-level employees.
  • Pursue additional growth and professional development opportunities.

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