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. Salary Range: $60,100 – $98,700 (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 For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits [https://www.exlservice.com/us-careers-and-benefits] 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 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 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! The posted base salary range is the hiring base salary range for this role. 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.