Outpatient Auditor II
EXL
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $65,000 - $75,000 per year
About the role
- Perform detailed audits of outpatient and professional fee claims across infusion, surgical, interventional radiology, and hospital outpatient services.
- Review CPT/HCPCS, APC, and revenue codes to confirm accurate reporting and reimbursement.
- Apply Medicare, NCCI, CPT, and AHA Coding Clinic guidelines to ensure coding compliance.
- Identify and document overpayments, discrepancies, or missed billing opportunities.
- Utilize encoder tools (3M, Webstrat, Optum Encoder) and EXL proprietary systems to review, validate, and process claims efficiently.
- Produce clear, concise audit findings and rationales that align with official coding guidelines.
- Stay current on regulatory updates, outpatient reimbursement changes, and clinical practice trends in infusion, surgery, and radiology.
- Meet and exceed EXL productivity and quality benchmarks while maintaining accuracy and compliance.
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 for multiple credentials
- 3+ years of professional 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.
- Hands-on experience auditing complex outpatient surgical and interventional cases (Preferred).
- Advanced knowledge of infusion and injection billing guidelines (Preferred).
- Experience with retrospective overpayment identification in hospital and professional outpatient claims (Preferred).
- Encoder experience (3M, Webstrat, Optum Encoder) (Preferred).
- Ability to work independently in a remote environment and manage competing priorities (Preferred).
- Strong written, verbal, and analytical communication skills (Preferred).
- Proficiency in Microsoft Excel, Word, and OneNote with general computer literacy (Preferred).
Benefits
- Collaborative team environment – Work with top-tier healthcare professionals who value your expertise.
- Professional development – Gain exposure to multiple specialties and continue expanding your knowledge base.
- Mentorship & growth opportunities – Learn from senior auditors and leaders while developing your career path.
- Work-life balance – Enjoy the flexibility of remote work with occasional travel to stay connected with colleagues.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
coding complianceauditingCPTHCPCSAPC reimbursement methodologiesinfusion billing guidelinesinterventional radiology codingsurgical codingoverpayment identificationclaim adjudication
Soft Skills
analytical communicationwritten communicationverbal communicationindependent worktime managementattention to detailproblem-solvingorganizational skillsadaptabilityteam collaboration
Certifications
Certified Coding Specialist (CCS)Registered Health Information Administrator (RHIA)Registered Health Information Technician (RHIT)Certified Professional Coder (CPC)