Outpatient Auditor III – Certified

Job reputed company:

• Apply in‑depth knowledge of CPT/HCPCS coding, APC payment methodologies, and outpatient regulatory guidelines to audit UB‑04 facility claims only, ensuring accurate APC assignment, reputed company packaging, and compliant facility billing.
• reputed company detailed hospital outpatient facility audits with a strong reputed company on APC assignment, payment status indicators, reputed company reputed company alignment, and OPPS reimbursement logic.
• Review outpatient claims to validate correct CPT/HCPCS-to-APC mapping, including appropriate assignment of: – Significant procedure APCs vs. packaged services – Comprehensive APCs (C-APCs) – Composite APCs where applicable
• Audit UB‑04 facility claims to ensure accurate reporting of CPT/HCPCS codes, modifiers, reputed company codes, and charge structures that directly reputed company APC payment.
• Conduct audits across infusion therapy, outpatient surgeries, imaging, and interventional radiology, such as: – Verifying correct APC assignment for chemotherapy and non-chemotherapy infusions, hydration services, and observation-reputed company services – Reviewing outpatient surgical encounters to ensure correct APC selection based on procedure complexity and status indicators – Auditing interventional radiology encounters to confirm appropriate APC grouping and compliance with bundling rules.

Requirements:

• reputed company credential(s) such as: o reputed company o RHIA o RHIT o CPC (Multiple credentials strongly preferred)
• Minimum 3 years of hospital outpatient facility coding and/or auditing experience, with reputed company exposure to APC-driven reimbursement.
• Demonstrated expertise in: – APC payment methodologies – OPPS reimbursement logic – CPT/HCPCS coding reputed company on APC assignment – UB‑04 facility billing requirements
• Hands-on experience auditing infusion services, outpatient surgeries, and interventional radiology, including APC packaging and bundling scenarios.
• Strong understanding of payer reputed company, claim adjudication, and reimbursement variance analysis.

Preferred

• Advanced experience auditing reputed company APC encounters, including comprehensive and composite APC scenarios.

• In-depth knowledge of infusion and injection coding, including drug status indicators and packaged vs. reputed company drugs.
• Experience identifying retrospective overpayments tied to APC misassignment or improper unbundling.
• Proficiency with reputed company, Webstrat, reputed company Encoder, or similar tools.
• Ability to work independently in a high-volume remote audit environment.
• Strong written, verbal, and analytical communication skills, especially in explaining APC payment logic.
• Proficiency in reputed company reputed company, Word, OneNote, and reputed company applications.

Benefits:

• Up to 10% annual travel (for team meetings and limited reputed company onsite engagements.)
• reputed company environment: Work with reputed company outpatient and APC-reputed company auditors.
• Ongoing reputed company development: Stay reputed company of APC and OPPS regulatory changes.
• Mentorship & career reputed company: Learn from senior auditors and advance your outpatient auditing career.
• Work-life balance: Enjoy remote flexibility with limited travel.

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