Outpatient Auditor II

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

📋 Description

• Conduct audits on outpatient claims, emphasizing APC groupings, revenue codes, CPT bundling regulations, and UB-04 facility coding standards.

• Ensure precise documentation and coding of technical elements such as nursing services, equipment usage, and the place of service.

• Independently verify facility charges and resource utilization, separate from provider claims.

• Perform comprehensive audits on infusion therapy, surgical services, interventional radiology, and various other hospital outpatient service lines.

• Review CPT and APC coding to confirm accurate reporting and reimbursement.

• Implement Medicare regulations, NCCI edits, CPT guidelines, and AHA Coding Clinic recommendations.

• Detect overpayments, identify coding discrepancies, and uncover missed reimbursement opportunities.

• Utilize platforms such as 3M, Webstrat, Optum Encoder, and EXL proprietary tools to analyze and manage claims.

• Generate clear and concise audit results in accordance with official coding standards.

• Remain updated on outpatient regulatory modifications, reimbursement developments, and trends in clinical practice.

• Achieve or surpass EXL's productivity, quality, and compliance benchmarks.

⛳️ Requirements

• One or more of the following credentials are necessary: Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Professional Coder (CPC).

• A minimum of 3 years of coding/auditing experience in professional and hospital outpatient settings, particularly in infusion, surgical, and interventional radiology cases.

• In-depth understanding of CPT/HCPCS, APC reimbursement methodologies, and official coding standards.

• Familiarity with payer contract terminology and claims adjudication procedures.

• Preferred experience in auditing complex outpatient surgical and interventional radiology cases.

• Advanced knowledge of infusion and injection coding regulations is preferred.

• Background in retrospective identification of overpayments for hospital and professional claims is preferred.

• Proficient in encoder tools, including 3M, Webstrat, and Optum, is preferred.

• Capability to work autonomously in a remote setting while managing multiple tasks is preferred.

• Strong written, verbal, and analytical communication abilities are preferred.

• Proficiency in Microsoft Excel, Word, OneNote, and general computer applications is preferred.

🏝️ Benefits

• Collaborative team environment.

• Opportunities for professional development and exposure to various specialties.

• Mentorship and growth opportunities.

• Flexible remote work options.

• Up to 10% annual travel for team meetings and occasional client onsite engagements.

• Additional benefits information can be found at https://www.exlservice.com/us-careers-and-benefits.