Quality Analyst IV - Diagnosis-Related Group, Healthcare

Title: Quality Analyst IV - Diagnosis-Related Group (DRG), Healthcare

Location: United States

Job Description:

EXL Health, is seeking an experienced Clinical Diagnosis-Related Group (DRG) Quality Analyst.  

This is a remote office opportunity. The Quality Analyst IV oversees work performed by the Clinical DRG auditors to ensure that EXL’s standard of accuracy is met. The analyst undertakes a quality review of random and targeted clinical DRG audits.  

A brief coding/auditing assessment may be included as part of the interview process

Salary Range is: $70k - $110k

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

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

• Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding 

• Responsible for reviewing the accuracy and consistency of clinical DRG auditing auditors to ensure audits are appropriately marked for findings and no findings 

• Mentor Clinical DRG auditors 

• Recommend process changes to improve quality and performance 

• Communicate with peers and management 

• Provide root cause analysis on errors 

• Perform other duties as assigned 

• Conduct all job functions and responsibilities in accordance with all company Compliance, Information Security and Regulatory policies, procedures and programs

Qualifications

• Minimum 5 years experience working with clinical validation audits 

Knowledge and Skills:  

• Superior auditing and monitoring skills  

• Ability to mentor and instruct  

• Excellent decision making skills and sound judgment  

• Thorough understanding of medical terminology and human physiology  

• Strong technical knowledge and ability to learn new systems quickly 

• Excellent oral/presentation and written communication skills  

• Ability to complete tasks efficiently and resolve problems within set timelines 

• Strong organizational skills and attention to detail  

• Ability to work in a team environment and independently as needed  

• Demonstrated flexibility and adaptability  

• Must be able to work under deadlines. Must be able to utilize independent decision-making skills in a wide variety of situations  

• Requires a high degree of accuracy in the performance of varied responsibilities.  

• Personal computer skills required. Must be self-motivated to complete work in a timely manner to meet deadlines  

• Strong interpersonal skills required 

Required Skills

• APR-DRG
• Attention To Consistency
• Computer Literacy
• Diagnosis-Related Group (DRG) Experience
• Internal Communications
• Interpersonal Relationship Building
• Leadership Capabilities
• MS-DRG
• Microsoft Excel
• Microsoft Word
• 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.