Auditor I – Outpatient

This is a fully remote position, open to applicants in United States.

📋 Description

• Execute comprehensive CPT/APC coding evaluations to confirm CPT coding assignments and APC reimbursements.

• Implement Medicare, NCCI, and various coding guidelines to specific claim scenarios.

• Utilize industry-standard and proprietary tools to enhance the identification of overpayments.

• Clearly and concisely document audit findings in accordance with AHA Coding Clinic Guidelines and CPT coding regulations.

• Employ workflow systems and encoder tools to make audit decisions, produce audit rationales, and accurately process claims through the workflow.

• Achieve or surpass program productivity and quality objectives, including maintaining the appeal success rate.

• Stay informed of and adhere to updates and changes in coding guidelines, reimbursement trends, client procedures, and requirements.

• Follow EXL policies and procedures, including compliance with HIPAA and relevant state and federal regulations.

• Assess outpatient medical records to ensure compliance with regulatory standards, payer guidelines, and organizational policies.

⛳️ Requirements

• One or more of the following credentials are necessary: CCS, RHIA, RHIT, or CPC.

• An associate degree or a minimum of 1 year of relevant experience.

• Familiarity with coding guidelines.

• Understanding of CPT coding, the Official Guidelines for Coding and Reporting, Coding Clinic Guidance, NCCI coding standards, and APC payment methodologies, including Medicare OPPS.

• Experience using encoder tools such as 3M, Webstrat, or Optum Encoder.

• Capability to work independently in a remote environment during EXL's core business hours.

• Exceptional time management and prioritization abilities.

• Strong written and verbal communication competencies.

• Excellent analytical skills and meticulous attention to detail.

• Proficient in Excel, Word, and OneNote.

• General computer literacy.

• Enthusiasm for outpatient auditing.

🏝️ Benefits

• Healthcare, vision, and dental coverage.

• 401(k) options available.

• Mentorship program with experienced professional advisors.

• Access to guidance and coaching.

• Opportunities for professional growth and development.

• Flexibility to work remotely from home.

• Chance to collaborate closely with seasoned healthcare consultants.

• Development of teamwork and time-management skills.