Outpatient Auditor III

EXL

Remote Certified Outpatient Facility Auditor at EXL Health focusing on APC reimbursement accuracy. Analyzing and auditing outpatient facility claims with a dedicated team of professionals.

Posted 7/8/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $70,000 - $90,000 per yearWebsite

About the role

Key responsibilities & impact

Perform detailed hospital outpatient facility audits with a strong focus on APC assignment, payment status indicators, revenue code alignment, and OPPS reimbursement logic.
Review outpatient claims to validate correct CPT/HCPCS-to-APC mapping, ensuring accurate reporting of CPT/HCPCS codes, modifiers, revenue codes, and charge structures that directly impact APC payment.
Audit UB-04 facility claims to evaluate APC packaging rules, including bundled payment of ancillary services, supplies and minor procedures, and drug administration services packaged into primary procedures.
Conduct audits across infusion therapy, outpatient surgeries, imaging, and interventional radiology to verify correct APC assignment.

Requirements

What you’ll need

Active credential(s) such as: CCS, RHIA, RHIT, CPC (Multiple credentials strongly preferred)
Minimum 3 years of hospital outpatient facility coding and/or auditing experience, with direct exposure to APC-driven reimbursement.
Demonstrated expertise in: APC payment methodologies, OPPS reimbursement logic, CPT/HCPCS coding impact 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 contracts, claim adjudication, and reimbursement variance analysis.

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

APC AssignmentCPT/HCPCS MappingOutpatient Claims ReviewBundled Payment AuditingInfusion Therapy AuditingInterventional Radiology AuditingRevenue Code AlignmentPayment Status IndicatorsAPC Packaging RulesOPPS Reimbursement Logic

Certifications

CCSRHIARHITCPC