Outpatient Auditor III

EXL

Remote outpatient facility auditor reviewing APC reimbursement, OPPS compliance, and UB-04 claims. EXL Health uses data, analytics, and AI to transform healthcare operations.

Posted 9/9/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $70,000 - $90,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in hospital outpatient facility audits, focusing on APC assignment, OPPS reimbursement logic, and CPT/HCPCS coding. Proficient in utilizing auditing tools and maintaining compliance with CMS regulations while producing clear audit findings.

Highest-signal resume keywords

APC Payment MethodologiesCPT/HCPCS CodingUB-04 Facility Billing3M, Webstrat, Optum EncoderActive CCS, RHIA, RHIT, or CPC Credential

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

APC AssignmentOPPS Reimbursement LogicInfusion Services AuditingInterventional Radiology AuditingCPT/HCPCS Code ValidationRevenue Code AlignmentBundling ComplianceOverpayment IdentificationReimbursement Variance AnalysisAPC Packaging Rules

Soft Skills

Analytical CommunicationWritten CommunicationVerbal CommunicationIndependent WorkAttention to Detail

Tools & Technologies

3MWebstratOptum EncoderEXL Proprietary SystemsMicrosoft ExcelMicrosoft WordMicrosoft OneNote

Certifications & Qualifications

CCSRHIARHITCPC

Industry Keywords

Hospital Outpatient Facility CodingAPC-Driven ReimbursementCMS OPPS RegulationsNCCI EditsAHA Coding Clinic Guidance

About the role

Key responsibilities & impact

Perform detailed hospital outpatient facility audits focused on APC assignment, payment status indicators, revenue code alignment, and OPPS reimbursement logic
Review claims to validate CPT/HCPCS-to-APC mapping, including significant procedure, packaged, comprehensive, and composite APCs
Audit UB-04 facility claims for accurate CPT/HCPCS codes, modifiers, revenue codes, and charge structures
Evaluate APC packaging rules for ancillary services, supplies, minor procedures, and drug administration services
Audit infusion therapy, outpatient surgeries, imaging, and interventional radiology encounters
Verify APC assignment for chemotherapy and non-chemotherapy infusions, hydration, and observation services
Review surgical encounters for APC selection based on procedure complexity and status indicators
Audit interventional radiology encounters for appropriate APC grouping and bundling compliance
Validate billing of technical components including nursing services, equipment, supplies, imaging contrast, and facility resources
Evaluate facility billing separately from professional claims
Apply CMS OPPS regulations, CPT rules, NCCI edits, and AHA Coding Clinic guidance
Identify overpayments, underpayments, misassigned APCs, inappropriate unbundling, and missed reimbursement opportunities
Use 3M, Webstrat, Optum Encoder, and EXL proprietary systems to analyze APC payment outcomes
Produce clear, defensible audit findings describing reimbursement impacts and compliance risks
Stay current on APC updates, OPPS rule changes, CMS transmittals, and payment indicator revisions
Meet or exceed EXL productivity, quality, and compliance standards

Requirements

What you’ll need

Active credential such as CCS, RHIA, RHIT, or CPC
Minimum 3 years of hospital outpatient facility coding and/or auditing experience with direct exposure to APC-driven reimbursement
Expertise in APC payment methodologies
Expertise in OPPS reimbursement logic
Knowledge of CPT/HCPCS coding impact on APC assignment
Knowledge of 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 contracts, claim adjudication, and reimbursement variance analysis
Advanced APC auditing experience, including comprehensive and composite APC scenarios preferred
Knowledge of infusion and injection coding, drug status indicators, and packaged versus paid drugs preferred
Experience identifying retrospective overpayments tied to APC misassignment or improper unbundling preferred
Proficiency with 3M, Webstrat, Optum Encoder, or similar tools preferred
Ability to work independently in a high-volume remote audit environment preferred
Strong written, verbal, and analytical communication skills preferred
Proficiency in Microsoft Excel, Word, OneNote, and related applications preferred

Benefits

Comp & perks

Remote work from home with limited travel
Up to 10% annual travel for team meetings and limited client onsite engagements
Collaborative environment with experienced outpatient and APC-focused auditors
Ongoing professional development on APC and OPPS regulatory changes
Mentorship and career growth opportunities
Work-life balance
Base salary range of $70,000–$90,000, with potential compensation above the range in higher-cost zones