Clinical Validation Auditor (CVA) Auditor III

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.)
A brief coding/auditing assessment may be included as part of the interview process
For more information on benefits and what we offer please visit us at  https://www.exlservice.com/us-careers-and-benefits

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.