oracle
Quality Analyst IV - Clinical Validation Auditor (CVA), Healthcare
EXL
Remote, USA
Mid
Remote
Discovered 2 weeks ago
Free
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EXL Health, is seeking an experienced Clinical Validation Auditor (CVA) 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.
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Responsibilities
- Apply clinical judgment for CVA audits to ensure accuracy of inpatient DRG coding
- Responsible for reviewing the accuracy and consistency of clinical CVA auditing auditors to ensure audits are appropriately marked for findings and no findings
- Mentor Clinical CVA 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
- - 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
- Current Registered Nurse license
- 5 plus 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
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