Company Overview and Culture
EXL (NASDAQ: EXLS) is a global analytics and digital solutions company that partners with clients to improve business outcomes and unlock growth. Bringing together deep domain expertise with robust data, powerful analytics, cloud, and AI, we create agile, scalable solutions and execute complex operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media, and retail, among others. Focused on creating value from data for driving faster decision-making and transforming operating models, EXL was founded on the core values of innovation, collaboration, excellence, integrity and respect. Headquartered in New York, our team is over 40,000 strong, with more than 50 offices spanning six continents. For information, visit www.exlservice.com.

For the past 20 years, EXL has worked as a strategic partner and won awards in its approach to helping its clients solve business challenges such as digital transformation, improving customer experience, streamlining business operations, taking products to market faster, improving corporate finance, building models to become compliant more quickly with new regulations, turning volumes of data into business opportunities, creating new channels for growth and better adapting to change. The business operates within four business units: Insurance, Health, Analytics, and Emerging businesses.

We are looking for a Clinical Validation Appeals Auditor to work 100% remotely from home! EXL was founded on the core values of innovation, collaboration, excellence, integrity, and respect.

Are you an experienced CVA Auditor looking for the next step in your career path? Is it time for a change? Explore this opportunity with a new, exciting, and dynamic growth-oriented team.

The CVA Appeal Auditor will review provider appeal responses on EXL Clinical Validation Audits. CVA Appeal Auditor shall review the provider appeal and supporting documentation and determine if the provider appeal would revise, or overturn EXL CVA Audit results.

The successful candidate will be passionate, quality focused and retain a 97% or greater accuracy rating. Successful extensive clinical and reimbursement background and is responsible for auditing inpatient medical records and applying clinical criteria and guidelines to ensure documented diagnoses are clinically valid.

Job Responsibilities:

• Review Clinical Validation provider appeals reviews to verify the accuracy of the MS-DRG assignment and reimbursement.
• Ability to support audit results with concise appeal responses citing.
• Work independently with passion and drive towards excellence
• Meet or exceed EXL established program productivity and quality goals.

Qualifications:

• 5+ years of experience with MS DRG with expert knowledge of AHA Coding Guidelines
• Strong clinical & analytical skills, with attention to detail
• Current industry trends specific to DRG reimbursement, provider contracts, payer policies, and audit regulations. Proficiency in Word, Access, Excel, and other applications.
• Excellent written and verbal communication skills.
• Experience with DRG encoder tools (3M, Webstrat, Pricers)

Education & Required Certification: Education (at least one of the following are required)

• Associate or Bachelor’s degree in nursing (active / unrestricted license)
• Clinical Documentation Improvement Practitioner CDIP
• Associates or Bachelor’s degree Health Information Management (RHIA or RHIT) with CDIP

Work Experience Requirements:

• Prior experience managing and responding to provider Clinical Validation appeals.
• Must have 5 years of Clinical Validation Audit experience with expert knowledge of DRG reimbursement methodologies, contract language.
• 5 years of clinical nursing experience in the inpatient setting
• 3 -5 years of inpatient coding experience competency in ICD-10
• An active and unrestricted RN license
• Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) preferred.
• Certified Documentation Improvement Practitioner (CDIP) or Certified Clinical Documentation Specialist (CCDS) preferred.
• Passionate about Clinical Validation Auditing, and a desire to work in an environment that thrives on teamwork, excellence, collaboration, inclusiveness, and support.

What We Offer:

• EXL Health offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with experienced, world class Healthcare consultants.
• You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills - key aspects for personal and professional growth.
• We provide guidance/ coaching to every employee through our mentoring program wherein every junior level employee is assigned a senior level professional as advisors.
• Sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond.
• Benefits we offer are Healthcare, Vision, Dental and 401k options.

EEO/Minorities/Females/Vets/Disabilities

Base Salary Range Disclaimer: The base salary range represents the low and high end of the EXL base salary range for this position. Actual salaries will vary depending on factors including but not limited to: location and experience. The base salary range listed is just one component of EXL's total compensation package for employees. Other rewards may include bonuses, as well as a Paid Time Off policy, and many region specific benefits.

Please also note that the data shared through the job application will be stored and processed by EXL in accordance with the EXL Privacy Policy.


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