Outpatient Auditor II

Are you a skilled Outpatient Auditor with deep expertise in infusion services, complex surgeries, interventional radiology, and hospital-based outpatient care? Do you bring a strong commitment to coding accuracy, regulatory compliance, and appropriate reimbursement? If so, EXL Health is excited to welcome you to our remote auditing team!

As a Remote Certified Outpatient Auditor , you’ll apply your in‑depth knowledge of CPT coding, outpatient regulatory guidelines, and APC reimbursement to review outpatient claims across a variety of clinical specialties. Your work will support providers, payers, and patients by validating billed CPT codes, identifying discrepancies, and ensuring adherence to industry standards.

This role is fully remote , with up to 10% annual travel for team meetings and occasional client onsite engagements.

Responsibilities
- Audit outpatient claims with a focus on APC groupings, revenue codes, CPT bundling rules, and UB‑04 facility coding requirements.

- Ensure accurate documentation and coding of technical components such as nursing services, equipment use, and place of service.

- Verify that facility charges and resource utilization are coded correctly and independently from provider claims.

- Conduct detailed audits across infusion therapy, surgical services, interventional radiology, and other hospital outpatient service lines.

- Review CPT, APC, to validate correct reporting and reimbursement.

- Apply Medicare regulations, NCCI edits, CPT rules, and AHA Coding Clinic guidance to support compliance.

- Identify overpayments, coding discrepancies, and missed reimbursement opportunities.

- Utilize encoder tools (3M, Webstrat, Optum Encoder) and EXL proprietary platforms to analyze and process claims.

- Produce clear and concise audit findings aligned with official coding rules.

- Stay current on outpatient regulatory changes, reimbursement updates, and clinical practice trends across infusion, surgery, and radiology.

- Meet or exceed EXL productivity, quality, and compliance standards.

Qualifications
Required

- 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.
Preferred

- Experience auditing complex outpatient surgical and interventional radiology cases.

- Advanced knowledge of infusion and injection coding regulations.

- Background in retrospective overpayment identification for hospital and professional claims.

- Proficiency with encoder tools (3M, Webstrat, Optum).

- Ability to work independently in a remote environment and manage multiple priorities.

- Strong written, verbal, and analytical communication skills.

- Proficiency in Microsoft Excel, Word, OneNote, and general computer applications.
What We Offer
At EXL Health, you’ll join a team dedicated to excellence, compliance, and innovation in healthcare.

- 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.
?? At EXL Health, your expertise matters. Join us to make an impact, advance your career, and contribute to the future of healthcare auditing.
?? Apply now to start your journey with EXL Health!
Pay range for this role is: $65k - $75k
For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.