[Remote] DRG Quality Analyst IV - Healthcare

Note: The job is a remote job and is open to candidates in USA. EXL is hiring a DRG Quality Analyst IV to oversee the quality and accuracy of clinical DRG audits. The role reviews random and targeted audits, mentors auditors, analyzes errors, and recommends process improvements.

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

Skills

• Minimum 5 years of experience working with clinical validation audits
• Active Coding Certification: CIC, CCS, CPC, RHIT, or RHIA
• 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

Benefits

• Remote work opportunity

Company Overview

Company H1B Sponsorship