Auditor I – Outpatient

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EXL

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

📦 Logistics

💰 $2M Venture Round on 2015-01

Healthcare • Insurance • Logistics

EXL is a business consulting and services firm that focuses on leveraging data to enhance business operations and decision-making. With a strong emphasis on collaboration and adaptability, EXL partners with organizations to address their unique needs and culture while integrating data science and technology solutions. The company's areas of expertise include operations management, decision analytics, digital transformation, and various industries such as healthcare, finance, and insurance. EXL's mission is to help clients drive business evolution and maintain competitive advantage through tailored solutions and effective use of data.

📋 Description

• Conduct thorough CPT/APC coding reviews to verify CPT coding assignments and APC reimbursement • Apply Medicare, NCCI, and other coding guidelines to claim scenarios • Use industry and proprietary tools to maximize overpayment identifications • Document audit results clearly and concisely using AHA Coding Clinic Guidelines and CPT coding rules • Use workflow systems and encoder tools to make audit determinations, generate audit rationales, and move claims through workflow correctly • Meet or exceed program productivity and quality goals, including uphold rate for appeals • Monitor and comply with changes and updates to coding guidelines, reimbursement trends, client processes, and requirements • Comply with EXL policies and procedures, including HIPAA and state and federal regulations • Review outpatient medical records for compliance with regulatory requirements, payer guidelines, and organizational policies

🎯 Requirements

• One or more of the following credentials required: CCS, RHIA, RHIT, or CPC • Associate degree or 1 year of experience • Knowledge of coding guidelines • Knowledge of CPT coding, Official Guidelines for Coding and Reporting, Coding Clinic Guidance, NCCI coding guidelines, and APC payment methodologies including Medicare OPPS • Experience with encoder tools such as 3M, Webstrat, or Optum Encoder • Ability to work independently in a remote environment during EXL core business hours • Excellent time management and work prioritization skills • Strong written and verbal communication skills • Strong analytical skills and attention to detail • Proficiency in Excel, Word, and OneNote • General computer literacy • Passion for outpatient auditing

🏖️ Benefits

• Healthcare, vision, and dental benefits • 401(k) options • Mentoring program with senior-level professional advisors • Guidance and coaching • Professional growth and development opportunities • Remote work from home • Opportunity to work closely with experienced healthcare consultants • Teamwork and time-management skill development