Outpatient Auditor II

EXL•United States,

3d•$65,000 - $75,000•Remote

About The Position

EXL Health is hiring a remote outpatient auditor to review claims across clinical specialties, with particular focus on infusion services, complex surgeries, interventional radiology, and hospital-based outpatient care. The role applies expertise in CPT coding, outpatient regulatory guidelines, and APC reimbursement to validate billed codes, identify discrepancies, and support accurate, compliant reimbursement for providers, payers, and patients. The position is fully remote and involves up to 10% annual travel for team meetings and occasional client onsite engagements. Auditors use encoder tools and EXL platforms to analyze claims, document findings according to official coding rules, and meet productivity, quality, and compliance standards.

Requirements

Hold one or more of the following credentials: Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Professional Coder (CPC).
Have 3 or more years of professional and hospital outpatient coding or auditing experience, including infusion, surgical, and interventional radiology cases.
Have strong knowledge of CPT/HCPCS, APC reimbursement methodologies, and official coding guidelines.
Be familiar with payer contract language and claim adjudication processes.

Nice To Haves

Multiple coding credentials.
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 such as 3M, Webstrat, and 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.

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, including 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 and APC reporting 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.
Use 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.