Outpatient Auditor III

October 14

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EXL

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

10,000+ employees

💰 $2M Venture Round on 2015-01

📋 Description

• Conduct CPT and Ambulatory Payment Classification (APC) reviews to verify the accuracy of CPT coding and APC reimbursement for outpatient and professional claims. • Apply Medicare, NCCI, and other coding guidelines to a wide range of claims and use both industry tools and EXL proprietary tools to identify potential overpayments. • Document audit findings and rationales clearly and professionally, utilizing AHA Coding Clinic and CPT coding rules. • Leverage proprietary workflow systems and encoder tools (3M, Webstrat, Optum Encoder) to make accurate audit determinations and effectively move claims through the workflow. • Meet or exceed EXL's productivity and quality goals, ensuring timely and accurate audit results. • Stay up-to-date on coding guideline changes and reimbursement trends, and apply this knowledge to improve audit outcomes. • Maintain compliance with EXL’s policies and procedures, including HIPAA and other state and federal regulations.

🎯 Requirements

• One or more of the following credentials: • - Certified Coding Specialist (CCS) • - Registered Health Information Administrator (RHIA) • - Registered Health Information Technician (RHIT) • - Certified Professional Coder (CPC) • - Preference given to candidates with multiple credentials • 3+ years of professional and hospital outpatient coding experience, including expertise in AHA and CPT Coding Guidelines and APC reimbursement methodologies. • Familiarity with healthcare payer contract language. • Experience with APC retrospective overpayment identification in specialties like surgical, radiology, etc. (Preferred) • Superior knowledge of CPT coding, Official Coding Guidelines, Coding Clinic Guidance, and National Correct Coding Initiative (NCCI) guidelines (Preferred). • Experience using encoder tools such as 3M, Webstrat, and Optum Encoder (Preferred). • Ability to work independently in a remote environment while delivering exceptional results during EXL’s core business hours (Preferred). • Excellent time management skills and ability to prioritize work (Preferred). • Strong analytical, written, and verbal communication skills (Preferred). • Proficiency in Excel, Word, and OneNote with a general understanding of computer systems (Preferred).

🏖️ Benefits

• Collaborative environment: Work alongside world-class healthcare consultants and be a part of a supportive team that values your input. • Career growth: Learn new skills and gain exposure to different aspects of business operations while working in a fast-paced and engaging environment. • Mentoring program: Receive guidance from experienced mentors who will help you develop professionally and provide career insights. • Professional development: We encourage continuous growth and provide opportunities for you to excel within EXL Health and beyond. • Work-life balance: Enjoy the flexibility of a remote work-from-home position, with occasional travel to expand your professional network.