Clinical Validation Auditor (CVA) Auditor III

Job 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. A brief coding/auditing assessment may be included as part of the interview process 🔍 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. 🎓 What We’re Looking For: - Registered Nurse (RN) with an active license. - 5+ years of acute care experience (hospital setting preferred)...