Outpatient Auditor III

🕒 4 days ago

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EXL

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10,000+ employees

💰 $2M Venture Round on 2015-01

Choosing a digital partner is about more than capabilities — it’s about collaboration and character.

📋 Description

• Perform detailed hospital outpatient facility audits with a strong focus on APC assignment, payment status indicators, revenue code alignment, and OPPS reimbursement logic. • Review outpatient claims to validate correct CPT/HCPCS-to-APC mapping, ensuring accurate reporting of CPT/HCPCS codes, modifiers, revenue codes, and charge structures that directly impact APC payment. • Audit UB-04 facility claims to evaluate APC packaging rules, including bundled payment of ancillary services, supplies and minor procedures, and drug administration services packaged into primary procedures. • Conduct audits across infusion therapy, outpatient surgeries, imaging, and interventional radiology to verify correct APC assignment.

🎯 Requirements

• Active credential(s) such as: CCS, RHIA, RHIT, CPC (Multiple credentials strongly preferred) • Minimum 3 years of hospital outpatient facility coding and/or auditing experience, with direct exposure to APC-driven reimbursement. • Demonstrated expertise in: APC payment methodologies, OPPS reimbursement logic, CPT/HCPCS coding impact on APC assignment, UB-04 facility billing requirements • Hands-on experience auditing infusion services, outpatient surgeries, and interventional radiology, including APC packaging and bundling scenarios. • Strong understanding of payer contracts, claim adjudication, and reimbursement variance analysis.

🏖️ Benefits

• Up to 10% annual travel (for team meetings and limited client onsite engagements) • Collaborative environment: Work with experienced outpatient and APC-focused auditors. • Ongoing professional development: Stay ahead of APC and OPPS regulatory changes. • Mentorship & career growth: Learn from senior auditors and advance your outpatient auditing career. • Work-life balance: Enjoy remote flexibility with limited travel.