Auditor III - Clinical Validation Auditor, Healthcare
Company Overview and Culture
EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 55,000 employees spanning six continents. For more information, visit http://www.exlservice.com.
About EXL Health
We leverage Human Ingenuity and domain expertise to help clients improve outcomes, optimize revenue and maximize profitability across the healthcare ecosystem. Technology, data and analytics are at the heart of our solutions. We collaborate closely with clients to transform how care is delivered, managed and paid.
EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Leveraging Human Ingenuity, we collaborate with our clients to solve complex problems and enhance their performance with nimble, scalable solutions. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem.
We help payers improve member care quality and network performance, manage population risk, and optimize revenue while decreasing administrative waste and reducing health claim expenditures. We help Pharmacy Benefit Managers (PBMs) manage member drug benefits and reduce drug spending while maintaining quality. We help provider organizations proactively manage risk, improve outcomes, and optimize network performance. We provide Life Sciences companies with enriched data, insights through advanced analytics and data visualization tools to get the right treatment to the right patient at the right time.
🌟 Now Hiring: Clinical Validation Auditor (Fully Remote). Use your clinical expertise to make a real impact – all from the comfort of your home!
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.
🔍 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)
- 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
✅ You’ll Be a Great Fit If You:
- 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
💼 Why Work at EXL?
At EXL, you’ll join a team that values collaboration, clinical accuracy, and continuous improvement. We offer the flexibility of remote work, a culture of support, and the opportunity to grow in the fast-evolving world of healthcare analytics.
Ready to take the next step in your clinical career? Apply today and make a difference with EXL!
To view our total rewards offered click here —> https://www.exlservice.com/us-careers-and-benefits
Base Salary Range Disclaimer: The base salary range represents the low and high end of the EXL base salary range for this position. Actual salaries will vary depending on factors including but not limited to: location and experience. The base salary range listed is just one component of EXL's total compensation package for employees. Other rewards may include bonuses, as well as a Paid Time Off policy, and many region specific benefits.
Application & Interview Impersonation Warning – Purposely impersonating another individual when applying and / or participating in an interview in order to obtain employment with EXL Service Holdings, Inc. (the “Company”) for yourself or for the other individual is a crime. We have implemented measures to deter and to uncover such unlawful conduct. If the Company identifies such fraudulent conduct, it will result in, as applicable, the application being rejected, an offer (if made) being rescinded, or termination of employment as well as possible legal action against the impersonator(s).
EXL may use artificial intelligence to create insights on how your candidate information matches the requirements of the job for which you applied. While AI may be used in the recruiting process, all final decisions in the recruiting and hiring process will be taken by the recruiting and hiring teams after considering a candidate’s full profile. As a candidate, you can choose to opt out of this artificial intelligence screening process. Your decision to opt out will not negatively impact your opportunity for employment with EXL.
Other details
- Pay Type Salary
- Employment Indicator Regular
- Min Hiring Rate $70,000.00
- Max Hiring Rate $80,000.00
- Telecommute % 100
- Required Education Bachelor’s Degree
- United States
- Virtual