Clinical Validation Auditor III

Title: Clinical Validation Auditor (CVA) Auditor III

Location: United States Remote; Pittsburgh, Pennsylvania

Department: Auditors

Job Description:

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.

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!

Salary range for this role is $70k - $80k

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits