Quality Analyst IV – Clinical Validation Auditor, Healthcare

Job Description: • Oversee work performed by the Clinical DRG auditors to ensure that EXL’s standard of accuracy is met • Undertake a quality review of random and targeted clinical DRG audits • Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding • Responsible for reviewing the accuracy and consistency of clinical DRG auditing auditors to ensure audits are appropriately marked for findings and no findings • Mentor Clinical DRG auditors • Recommend process changes to improve quality and performance • Communicate with peers and management • Provide root cause analysis on errors • Perform other duties as assigned • Conduct all job functions and responsibilities in accordance with all company Compliance, Information Security and Regulatory policies, procedures and programs Requirements: • Current Registered Nurse license • Minimum 5 years experience working with clinical validation audits • Superior auditing and monitoring skills • Ability to mentor and instruct • Excellent decision making skills and sound judgment • Thorough understanding of medical terminology and human physiology • Strong technical knowledge and ability to learn new systems quickly • Excellent oral/presentation and written communication skills • Ability to complete tasks efficiently and resolve problems within set timelines • Strong organizational skills and attention to detail • Ability to work in a team environment and independently as needed • Demonstrated flexibility and adaptability • Must be able to work under deadlines. Must be able to utilize independent decision-making skills in a wide variety of situations • Requires a high degree of accuracy in the performance of varied responsibilities. • Personal computer skills required. Must be self-motivated to complete work in a timely manner to meet deadlines • Strong interpersonal skills required Benefits: • For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits Apply tot his job Apply To this Job