Clinical Validation Auditor (CVA) Auditor III

Clinical Validation Auditor

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

Salary range for this role is $70k - $95k

The posted range is the hiring range for this role a subset of the broader range available to employees over time and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.

Responsibilities

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 worrywe'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

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!

Required Skills

• Attention To Consistency
• Computer Literacy
• Interpersonal Relationship Building
• Leadership Capabilities
• Microsoft Office
• RN, LPN, LVN
• Working under Pressure

About Us

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 54,000 employees spanning six continents. For more information, visit EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL's Human Resources team, as well as our hiring managers.