CVA Quality Analyst

EXL Health is seeking an experienced Clinical 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. The analyst applies expert clinical knowledge in the quality auditing of inpatient medical records to confirm the appropriate validation of the provider's billed DRG code.

• 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
• Utilize extensive clinical and industry knowledge to identify audit trends and identify referrals for DRG coding review
• Provide root cause analysis on errors
• Utilize industry and EXL proprietary tools in the DRG assignment process
• Write professional communications documenting audit findings and supporting rationales.
• Recommend process changes to improve quality and performance
• Communicate with peers and management
• 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

• Registered Nurse, Associate's or Bachelor's degree
• 5+ years of acute care nursing experience with preference given to candidates with prior clinical or coding validation audit experience.
• Prefer candidate with prior DRG retrospective overpayment identification auditing experience.
• Prefer candidate with prior readmission (PPR) auditing experience.
• Preference given to candidates with CCS, RHIA, or RHIT coding credentials.

Knowledge and Skills:

• Superior auditing and monitoring skills
• Ability to mentor
• Extensive knowledge and understanding of clinical criteria documentation requirements used to successfully substantiate code assignments.
• Experience with DRG encoder tools (3M, Webstrat).
• Works independently in a remote environment and delivers exceptional results during EXL core business hours.
• Possesses excellent time management and work prioritization skills.
• Takes ownership of problem solving.
• Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail.
• Proficient in Excel, Word, and OneNote with general computer literacy.
• Passionate about DRG Auditing with a desire to work in an environment thriving on teamwork, excellence, collaboration