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Quality Analyst - Diagnosis-Related Group (DRG), Healthcare

EXLUnited States🇺🇸United States

Quick overview

SeniorityMid Senior
Work modeRemote
LocationUnited States
AuditingComplianceMedical TerminologyRoot Cause Analysis

Job description

EXL Health, is seeking an experienced Clinical Diagnosis-Related Group (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.

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.

  • 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
  • Minimum 5 years 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.

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