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

Active credential(s) such as:
CCS
RHIA
RHIT
CPC
(Multiple credentials preferred)
Minimum 3 years of outpatient hospital and professional coding/auditing experience, including infusion, surgical, and interventional radiology cases.
Strong understanding of CPT coding, APC reimbursement methodologies, and official coding guidelines.
Familiarity with payer contracts and claim adjudication processes.
Preferred
Experience auditing complex outpatient surgical and interventional radiology cases.
Advanced knowledge of infusion and injection coding regulations.
Background in retrospective overpayment identification for hospital and professional claims.
Proficiency with encoder tools (3M, Webstrat, Optum).
Ability to work independently in a remote environment and manage multiple priorities.
Strong written, verbal, and analytical communication skills.
Proficiency in Microsoft Excel, Word, OneNote, and general computer applications.

Collaborative environment: Work with experienced healthcare professionals who value your expertise.
Ongoing professional development: Expand your knowledge across multiple specialties and coding domains.
Mentorship & career growth: Learn from senior auditors and leaders while advancing your career path.
Work-life balance: Enjoy the flexibility of remote work with occasional travel to maintain team connection.

Outpatient Auditor III

Key skills