Auditor I - Outpatient

🕒 August 6, 2025

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EXL

WebsiteLinkedInAll Job Openings

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

• Conduct thorough CPT/APC coding reviews to verify the accuracy of the CPT coding assignment and APC reimbursement. • Apply knowledge of Medicare, NCCI and other coding guidelines to a variety of claim scenarios and effectively utilize industry and proprietary tools to maximize overpayment identifications. • Document audit results in a clear, concise, and effective manner using AHA Coding Clinic Guidelines and CPT coding rules and guidelines. • Utilize proprietary workflow systems and encoder tools (e.g., 3M, Webstrat, Optum Encoder etc.) efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly. • Meet or exceed EXL established program productivity and quality goals, including uphold rate for appeals. • Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements. • Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.

🎯 Requirements

• Required one or more of the following credentials: CCS, RHIA, RHIT, CPC • Associates degree or 1 year of experience • Knowledge of coding guidelines

🏖️ Benefits

• 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 highly 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