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EXL Health, is seeking an experienced Clinical Diagnosis-Related Group (DRG) Quality Analyst. Â
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. Â
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 codingÂ
- Responsible for reviewing the accuracy and consistency of clinical DRG auditing auditors to ensure audits are appropriately marked for findings and no findingsÂ
- Mentor Clinical DRG auditorsÂ
- Recommend process changes to improve quality and performanceÂ
- Communicate with peers and managementÂ
- Provide root cause analysis on errorsÂ
- Perform other duties as assignedÂ
- 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 auditsÂ
Knowledge and Skills:Â Â
- Superior auditing and monitoring skills Â
- Ability to mentor and instruct Â
- Excellent decision making skills and sound judgment Â
- Thorough understanding of medical terminology and human physiology Â
- Strong technical knowledge and ability to learn new systems quicklyÂ
- Excellent oral/presentation and written communication skills Â
- Ability to complete tasks efficiently and resolve problems within set timelinesÂ
- Strong organizational skills and attention to detail Â
- Ability to work in a team environment and independently as needed Â
- Demonstrated flexibility and adaptability Â
- Must be able to work under deadlines. Must be able to utilize independent decision-making skills in a wide variety of situations Â
- Requires a high degree of accuracy in the performance of varied responsibilities. Â
- Personal computer skills required. Must be self-motivated to complete work in a timely manner to meet deadlines Â
- Strong interpersonal skills requiredÂ
EXL is the indispensable partner for leading businesses in data-led industries such as insurance, banking and financial services, healthcare, retail and logistics. We bring a unique combination of data, advanced analytics, digital technology and industry expertise to help our clients turn data into insights, streamline operations, improve customer experience, and transform their business. Our partnerships with clients are built on a foundation of collaboration – and we’ve been chosen as a partner by nine of the top ten leading US insurance companies, nine of the top 20 global banks, and six of the top ten US health care payers. We function as one team to make your goals our goals, whether that’s unlocking the value of generative AI or embedding analytics into workflows that reduce risk or power your growth. Clients choose EXL as their transformation partner for many reasons. Our geographic diversity make talent all over the world instantly accessible. Digital accelerators enable unmatched speed-to-value, letting you realize results fast. It’s our people that truly set us apart, though, including the 1,500 data scientists we have dedicated to our generative AI practice. And our more than twenty years of experience in delivering business services, garnering stellar client references, and maintaining a solid balance sheet are reassuring to our C-suite clients. Find out for yourself why clients, employees, and analysts think we’re some of the best in the business. Contact us to see how we can help you achieve your goals.
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