Clinical Validation Auditor - Auditor III

Title: Clinical Validation Auditor (CVA) Auditor III

Location: Remote US

Department: Auditors

• Job Identification22133
• Job RoleAuditors-DRG CVA
• Experience (In Years)0-3

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.

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.)

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.

Required Skills

• Attention To Consistency
• CCS, RHIT, RHIA
• Computer Literacy
• DRG Auditing
• Internal Communications
• Microsoft Office
• Registered Nurse
• Working under Pressure