DRG Quality Analyst IV - Healthcare

This is a remote office opportunity. The DRG Quality Analyst 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.  

A brief coding/auditing assessment may be included as part of the interview process

Salary Range is: $85k - $110k

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

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

Qualifications

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

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  
• 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 

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.