Outpatient Auditor II

Are you an experienced Outpatient Auditor with a strong background in infusion services, complex surgery, interventional radiology, and hospital-based care? Do you take pride in ensuring coding accuracy, compliance, and fair reimbursement? If so, we invite you to join our remote auditing team at EXL Health!

As a Remote Certified Outpatient Auditor, you’ll leverage your deep knowledge of CPT coding, outpatient guidelines, and APC reimbursement to audit outpatient and professional fee records across a wide range of specialties. Your expertise will directly support providers, payers, and patients by validating billed CPT codes, identifying discrepancies, and ensuring compliance with coding regulations.

This role offers a fully remote work environment with up to 10% travel annually for team meetings or client engagements.

Key Responsibilities

• 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.

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

• Hands-on experience auditing complex outpatient surgical and interventional cases.
• Advanced knowledge of infusion and injection billing guidelines.
• Experience with retrospective overpayment identification in hospital and professional outpatient claims.
• Encoder experience (3M, Webstrat, Optum Encoder).
• Ability to work independently in a remote environment and manage competing priorities.
• Strong written, verbal, and analytical communication skills.
• Proficiency in Microsoft Excel, Word, and OneNote with general computer literacy.

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