Outpatient Auditor II

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

📋 Description

• Review outpatient claims with an emphasis on APC groupings, revenue codes, CPT bundling rules, and UB-04 facility coding standards.

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

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

• Perform thorough audits in areas such as infusion therapy, surgical services, interventional radiology, and other hospital outpatient service lines.

• Analyze CPT and APC reporting to confirm accurate reimbursement.

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

• Detect overpayments, coding errors, and overlooked reimbursement opportunities.

• Utilize 3M, Webstrat, Optum Encoder, and EXL proprietary platforms for claims analysis and processing.

• Generate clear and concise audit results that align with official coding standards.

• Remain informed about changes in outpatient regulations, updates on reimbursement, and trends in clinical practice.

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

⛳️ Requirements

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

• Minimum of 3 years of experience in professional and hospital outpatient coding/auditing, specifically in infusion, surgical, and interventional radiology cases.

• In-depth understanding of CPT/HCPCS, APC reimbursement methods, and established coding guidelines.

• Knowledge of payer contract terminology and the claim adjudication process.

• Experience in auditing intricate outpatient surgical and interventional radiology cases.

• Advanced understanding of coding regulations for infusion and injection services.

• Experience in identifying retrospective overpayments for both hospital and professional claims.

• Proficiency with encoder tools, including 3M, Webstrat, and Optum.

• Capability to work autonomously in a remote setting while managing multiple responsibilities.

• Strong skills in written, verbal, and analytical communication.

• Proficient in Microsoft Excel, Word, OneNote, and general computer applications.

🏝️ Benefits

• Collaborative team environment.

• Opportunities for professional development and exposure to various specialties.

• Mentorship and growth potential.

• Flexible remote work options.

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