[Hiring] Clinical Validation Auditor III @EXL

Role Description

Are you a nurse with a strong understanding of inpatient care and a passion for getting the details right? Join EXL as a Clinical Validation Auditor and help ensure medical claims are coded accurately and fairly. This is a fully remote position where you’ll use your clinical judgment to review medical records, validate billed DRG codes, and help identify overpayments.

• Salary Range: $70,000 – $85,000 (based on experience, skills, and qualifications)
• Location: 100% Remote (U.S.-based)
• Up to 10% annual travel (for team meetings and limited client onsite engagements)
• A brief coding/auditing assessment may be included as part of the interview process

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.

Qualifications

• 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.

Requirements

• 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.

Benefits

• Flexibility of remote work.
• Culture of support.
• Opportunity to grow in the fast-evolving world of healthcare analytics.