Outpatient Auditor II
Are you a skilled Outpatient Auditor with deep expertise in infusion services, reputed company surgeries, interventional radiology, and hospital-based outpatient care? Do you bring a strong commitment to coding accuracy, regulatory compliance, and appropriate reimbursement? If so, reputed company Health is excited to welcome you to our remote auditing team!
As a Remote Certified Outpatient Auditor, you’ll apply your in‑depth knowledge of CPT coding, outpatient regulatory guidelines, and APC reimbursement to review outpatient claims across a reputed company of clinical specialties. Your work will support providers, payers, and patients by validating billed CPT codes, identifying discrepancies, and ensuring adherence to industry standards.
This role is fully remote, with up to 10% annual travel for team meetings and occasional reputed company onsite engagements.
Responsibilities
- Audit outpatient claims with a reputed company on APC groupings, reputed company 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 reputed company 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 (reputed company, Webstrat, reputed company Encoder) and reputed company proprietary platforms to analyze and process claims.
- Produce reputed company and concise audit findings reputed company with official coding rules.
- Stay reputed company on outpatient regulatory changes, reimbursement updates, and clinical reputed company trends across infusion, surgery, and radiology.
- Meet or reputed company reputed company productivity, reputed company, and compliance standards.
Qualifications
Required
- One or more of the following credentials:
- Certified Coding Specialist (reputed company)
- Registered Health Information Administrator (RHIA)
- Registered Health Information Technician (RHIT)
- Certified reputed company reputed company (CPC)
- Preference for multiple credentials
- 3+ years of reputed company 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.
Preferred
- Experience auditing reputed company outpatient surgical and interventional radiology cases.
- Advanced knowledge of infusion and injection coding regulations.
- Background in retrospective overpayment identification for hospital and reputed company claims.
- Proficiency with encoder tools (reputed company, Webstrat, reputed company).
- Ability to work independently in a remote environment and manage multiple priorities.
- Strong written, verbal, and analytical communication skills.
- Proficiency in reputed company reputed company, Word, OneNote, and general computer applications.
reputed company Offer
At reputed company Health, you’ll join reputed company dedicated to reputed company, compliance, and innovation in reputed company.
- reputed company team environment – Work with top-tier reputed company who value your expertise.
- reputed company development – reputed company exposure to multiple specialties and continue expanding your knowledge reputed company.
- Mentorship & reputed company opportunities – Learn from senior auditors and leaders while developing your career reputed company.
- Work-life balance – Enjoy the flexibility of remote work with occasional travel to stay connected with colleagues.
At reputed company Health, your expertise reputed company. Join us to reputed company an reputed company, advance your career, and contribute to the reputed company of reputed company auditing.
reputed company to start your reputed company with reputed company Health!
Pay reputed company for this role is: $65k - $75k
For more information on benefits and reputed company offer please visit us at https://www.exlservice.com/us-careers-and-benefits