Outpatient Auditor III

🕒 April 3

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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

• Audit outpatient claims with a focus on APC groupings, revenue codes, CPT bundling rules, and UB‑04 facility coding requirements. • Ensure accurate documentation and coding of technical components such as nursing services, equipment use, and place of service. • Verify that facility charges and resource utilization are coded correctly and independently from provider claims. • Conduct detailed audits across infusion therapy, surgical services, interventional radiology, and other hospital outpatient service lines. • Review CPT, APC, to validate correct reporting and reimbursement. • Apply Medicare regulations, NCCI edits, CPT rules, and AHA Coding Clinic guidance to support compliance. • Identify overpayments, coding discrepancies, and missed reimbursement opportunities. • Utilize encoder tools (3M, Webstrat, Optum Encoder) and EXL proprietary platforms to analyze and process claims. • Produce clear and concise audit findings aligned with official coding rules. • Stay current on outpatient regulatory changes, reimbursement updates, and clinical practice trends across infusion, surgery, and radiology. • Meet or exceed EXL productivity, quality, and compliance standards.

🎯 Requirements

• Active credential(s) such as: CCS, RHIA, RHIT, CPC (Multiple credentials preferred) • Minimum 3 years of outpatient hospital and professional coding/auditing experience, including infusion, surgical, and interventional radiology cases. • Strong understanding of CPT coding, APC reimbursement methodologies, and official coding guidelines. • Familiarity with payer contracts and claim adjudication processes. • Preferred: Experience auditing complex outpatient surgical and interventional radiology cases. • Advanced knowledge of infusion and injection coding regulations. • Background in retrospective overpayment identification for hospital and professional claims. • Proficiency with encoder tools (3M, Webstrat, Optum). • Ability to work independently in a remote environment and manage multiple priorities. • Strong written, verbal, and analytical communication skills. • Proficiency in Microsoft Excel, Word, OneNote, and general computer applications.

🏖️ Benefits

• Collaborative environment: Work with experienced healthcare professionals who value your expertise. • Ongoing professional development: Expand your knowledge across multiple specialties and coding domains. • Mentorship & career growth: Learn from senior auditors and leaders while advancing your career path. • Work-life balance: Enjoy the flexibility of remote work with occasional travel to maintain team connection.