Outpatient Auditor II

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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

• 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 facility charges and resource utilization independently from provider claims • Conduct detailed audits across infusion therapy, surgical services, interventional radiology, and other hospital outpatient service lines • Review CPT and APC coding to validate correct reporting and reimbursement • Apply Medicare regulations, NCCI edits, CPT rules, and AHA Coding Clinic guidance • Identify overpayments, coding discrepancies, and missed reimbursement opportunities • Use 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 • Meet or exceed EXL productivity, quality, and compliance standards

🎯 Requirements

• One or more required credentials: Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Professional Coder (CPC) • 3+ years of professional and hospital outpatient coding/auditing experience, including infusion, surgical, and interventional radiology cases • Strong knowledge of CPT/HCPCS, APC reimbursement methodologies, and official coding guidelines • Familiarity with payer contract language and claim adjudication processes • Experience auditing complex outpatient surgical and interventional radiology cases preferred • Advanced knowledge of infusion and injection coding regulations preferred • Background in retrospective overpayment identification for hospital and professional claims preferred • Proficiency with encoder tools including 3M, Webstrat, and Optum preferred • Ability to work independently in a remote environment and manage multiple priorities preferred • Strong written, verbal, and analytical communication skills preferred • Proficiency in Microsoft Excel, Word, OneNote, and general computer applications preferred

🏖️ Benefits

• Collaborative team environment • Professional development and exposure to multiple specialties • Mentorship and growth opportunities • Flexible remote work • Up to 10% annual travel for team meetings and occasional client onsite engagements • Additional benefits information provided at https://www.exlservice.com/us-careers-and-benefits