Home Health Auditor III
EXL
Outpatient Auditor III
EXL
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $70,000 - $80,000 per year
Job Level
Mid-LevelSenior
About the role
- Conduct CPT and Ambulatory Payment Classification (APC) reviews to verify the accuracy of CPT coding and APC reimbursement for outpatient and professional claims.
- Apply Medicare, NCCI, and other coding guidelines to a wide range of claims and use both industry tools and EXL proprietary tools to identify potential overpayments.
- Document audit findings and rationales clearly and professionally, utilizing AHA Coding Clinic and CPT coding rules.
- Leverage proprietary workflow systems and encoder tools (3M, Webstrat, Optum Encoder) to make accurate audit determinations and effectively move claims through the workflow.
- Meet or exceed EXL's productivity and quality goals, ensuring timely and accurate audit results.
- Stay up-to-date on coding guideline changes and reimbursement trends, and apply this knowledge to improve audit outcomes.
- Maintain compliance with EXL’s policies and procedures, including HIPAA and other state and federal regulations.
Requirements
- One or more of the following credentials:
- - Certified Coding Specialist (CCS)
- - Registered Health Information Administrator (RHIA)
- - Registered Health Information Technician (RHIT)
- - Certified Professional Coder (CPC)
- - Preference given to candidates with multiple credentials
- 3+ years of professional and hospital outpatient coding experience, including expertise in AHA and CPT Coding Guidelines and APC reimbursement methodologies.
- Familiarity with healthcare payer contract language.
- Experience with APC retrospective overpayment identification in specialties like surgical, radiology, etc. (Preferred)
- Superior knowledge of CPT coding, Official Coding Guidelines, Coding Clinic Guidance, and National Correct Coding Initiative (NCCI) guidelines (Preferred).
- Experience using encoder tools such as 3M, Webstrat, and Optum Encoder (Preferred).
- Ability to work independently in a remote environment while delivering exceptional results during EXL’s core business hours (Preferred).
- Excellent time management skills and ability to prioritize work (Preferred).
- Strong analytical, written, and verbal communication skills (Preferred).
- Proficiency in Excel, Word, and OneNote with a general understanding of computer systems (Preferred).
Benefits
- Collaborative environment: Work alongside world-class healthcare consultants and be a part of a supportive team that values your input.
- Career growth: Learn new skills and gain exposure to different aspects of business operations while working in a fast-paced and engaging environment.
- Mentoring program: Receive guidance from experienced mentors who will help you develop professionally and provide career insights.
- Professional development: We encourage continuous growth and provide opportunities for you to excel within EXL Health and beyond.
- Work-life balance: Enjoy the flexibility of a remote work-from-home position, with occasional travel to expand your professional network.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
CPT codingAPC reimbursementAHA Coding GuidelinesNational Correct Coding Initiative (NCCI) guidelinesoverpayment identificationhealthcare payer contract languageaudit documentationcoding compliance
Soft skills
time managementanalytical skillswritten communicationverbal communicationindependent workprioritization
Certifications
Certified Coding Specialist (CCS)Registered Health Information Administrator (RHIA)Registered Health Information Technician (RHIT)Certified Professional Coder (CPC)
