Note: The job is a remote job and is open to candidates in USA. EXL is a healthcare operations and consulting company seeking a Quality Analyst to oversee the accuracy and consistency of clinical DRG audits. The role reviews inpatient medical records, mentors clinical auditors, analyzes audit errors and trends, documents findings, and recommends process improvements.
Responsibilities
- 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
- Utilize extensive clinical and industry knowledge to identify audit trends and identify referrals for DRG coding review
- Provide root cause analysis on errors
- Utilize industry and EXL proprietary tools in the DRG assignment process
- Write professional communications documenting audit findings and supporting rationales
- Recommend process changes to improve quality and performance
- Communicate with peers and management
- 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
Skills
- Registered Nurse, Associate's or Bachelor's degree
- 5+ years of acute care nursing experience
- Superior auditing and monitoring skills
- Ability to mentor
- Extensive knowledge and understanding of clinical criteria documentation requirements used to successfully substantiate code assignments
- Experience with DRG encoder tools (Solventum/3M, TruBridge, Webstrat)
- Possesses excellent time management and work prioritization skills
- Takes ownership of problem solving
- Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail
- Proficient in Excel, Word, and OneNote with general computer literacy
- With preference given to candidates with prior clinical or coding validation audit experience
- Prefer candidate with prior DRG retrospective overpayment identification auditing experience
- Prefer candidate with prior readmission (PPR) auditing experience
- Preference given to candidates with CCS, RHIA, or RHIT coding credentials
Benefits
- This is a remote office opportunity.
- An exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions.
- From your very first day, you get an opportunity to work closely with highly experienced, world class Healthcare consultants.
- You can expect to learn many aspects of businesses that our clients engage in.
- You will also learn effective teamwork and time-management skills—key aspects for personal and professional growth.
- We provide guidance/coaching to every employee through our mentoring program wherein every junior-level employee is assigned a senior-level professional as an advisor.
- The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond
Company Overview
Company H1B Sponsorship