Quality Analyst – Clinical Audit

Job Description

Location: Remote (U.S.-Based)

The Quality Analyst is responsible for executing activities outlined in the Service Quality Plan and identifying auditor- and program-level improvement opportunities. This role partners closely with clinical auditors and production teams to ensure compliance with established guidelines, accuracy standards, and client requirements.

The ideal candidate brings clinical audit or DRG validation experience, demonstrates strong analytical thinking, and is comfortable providing structured feedback and coaching in a performance-based environment.

Responsibilities:

• Perform quality monitoring of claims, cases, transactions, and/or telephonic interactions
• Conduct clinical validation and audit quality reviews
• Provide structured feedback to auditors and clinical team members
• Mentor and coach team members on process-level and compliance-related issues
• Monitor adherence to regulatory standards and internal procedures
• Report program-level quality metrics to process owners and leadership
• Participate in and support calibration sessions and performance review meetings
• Conduct refresher training based on identified error trends
• Communicate process updates and maintain documentation logs
• Perform root cause analysis to identify trends and recommend process improvements
• Identify risk areas and recommend preventive corrective actions

Qualifications:

• Registered Nurse (RN) required
• CIC or CCS certification preferred
• Prior DRG validation or inpatient audit experience strongly preferred
• Minimum one year experience in a Team Lead or equivalent role
• Experience in U.S. healthcare claims, medical coding, billing, revenue cycle management, or health plan operations
• Working knowledge of CMS guidelines, Medicaid regulations, ICD-9/10, CPT, and HCPCS
• Practical clinical experience in hospital, physician office, or post-acute setting preferred
• Strong communication and coaching skills
• Ability to analyze data and translate findings into actionable improvements

Schedule & Work Environment:

• Fully remote position
• Monday through Friday, standard business hours
• Secure, dedicated home workspace required
• Reliable high-speed internet connectivity required
• Prolonged computer-based review and documentation typical

Salary Range:

The salary range for this position is $90,000 – $115,000 annually (approximately $43.27 – $55.29 per hour), based on experience. Compensation will be determined by licensure, certification, clinical validation expertise, and internal market alignment.

Interview Process:

Selected candidates will complete an initial screening with TalentLNX followed by interviews with Clinical Audit Leadership and Quality Management.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and prohibits discrimination and harassment of any kind. We are dedicated to building a diverse workforce and fostering an inclusive work environment where all employees and candidates are treated with respect and dignity. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or any other protected status under applicable law. We actively seek to recruit, develop, and retain talented individuals from diverse backgrounds, and we encourage all qualified candidates to apply for our job opportunities.