Outpatient Auditor III, Healthcare

DS Technologies Inc

144d•$70,000 - $80,000•Remote

About The Position

As a Remote Certified Outpatient Auditor, you’ll bring your expert knowledge of outpatient coding, CPT coding guidelines, and reimbursement methodologies to audit outpatient and professional fee medical records. Your work will directly contribute to validating or revising the provider’s billed CPT codes and ensuring claims are accurate, fair, and compliant. This role offers a fully remote work experience with possible 10% travel per year. The rest of the time, you'll enjoy the flexibility of working from your home office.

Requirements

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 given to candidates with multiple credentials
3+ years of professional and hospital outpatient coding experience, including expertise in AHA and CPT Coding Guidelines and APC reimbursement methodologies.
Familiarity with healthcare payer contract language.
CCS
CPC
Outpatient Code Editor
RHIA
RHIT

Nice To Haves

Experience with APC retrospective overpayment identification in specialties like surgical, radiology, etc.
Superior knowledge of CPT coding, Official Coding Guidelines, Coding Clinic Guidance, and National Correct Coding Initiative (NCCI) guidelines.
Experience using encoder tools such as 3M, Webstrat, and Optum Encoder.
Ability to work independently in a remote environment while delivering exceptional results during EXL’s core business hours.
Excellent time management skills and ability to prioritize work.
Strong analytical, written, and verbal communication skills.
Proficiency in Excel, Word, and OneNote with a general understanding of computer systems.

Responsibilities

Conduct CPT and Ambulatory Payment Classification (APC) reviews to verify the accuracy of CPT coding and APC reimbursement for outpatient and professional claims.
Apply Medicare, NCCI, and other coding guidelines to a wide range of claims and use both industry tools and EXL proprietary tools to identify potential overpayments.
Document audit findings and rationales clearly and professionally, utilizing AHA Coding Clinic and CPT coding rules.
Leverage proprietary workflow systems and encoder tools (3M, Webstrat, Optum Encoder) to make accurate audit determinations and effectively move claims through the workflow.
Meet or exceed EXL's productivity and quality goals, ensuring timely and accurate audit results.
Stay up-to-date on coding guideline changes and reimbursement trends and apply this knowledge to improve audit outcomes.
Maintain compliance with EXL’s policies and procedures, including HIPAA and other state and federal regulations.