Outpatient Auditor III

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.

• 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.

Required

• Active credential(s) such as: 
  • CCS
  • RHIA
  • RHIT
  • CPC
  • (Multiple credentials preferred)
• Minimum 3 years of outpatient hospital and professional coding/auditing experience, including infusion, surgical, and interventional radiology cases.
• Strong understanding of CPT coding, APC reimbursement methodologies, and official coding guidelines.
• Familiarity with payer contracts 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

Join a high-performing team at EXL Health committed to accuracy, compliance, and continuous improvement in healthcare auditing.

• Collaborative environment: Work with experienced healthcare professionals who value your expertise.
• Ongoing professional development: Expand your knowledge across multiple specialties and coding domains.
• Mentorship & career growth: Learn from senior auditors and leaders while advancing your career path.
• Work-life balance: Enjoy the flexibility of remote work with occasional travel to maintain team connection.

🌟 Your expertise makes a difference.
Join EXL Health to build your career, strengthen healthcare compliance, and make an impact across the industry.

👉 Apply today to begin your journey with EXL Health!

Salary Range for this role is $70,000 - $80,000

0-10% travel may be required.

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits