Outpatient Auditor III - Remote Certified

EXL • United States,

7d • $70,000 - $90,000 • Remote

About The Position

EXL Health is seeking a highly skilled auditor to join our growing remote outpatient auditing team. This role focuses exclusively on facility-based outpatient claims and APC reimbursement. The ideal candidate will specialize in hospital outpatient facility coding and reimbursement. As a Remote Certified Outpatient Facility Auditor, you will apply your in-depth knowledge of CPT/HCPCS coding, APC payment methodologies, and outpatient regulatory guidelines to audit UB-04 facility claims only, ensuring accurate APC assignment, proper packaging, and compliant facility billing.

Requirements

• Experienced Outpatient Facility Auditor.
• Strong APC reimbursement expertise in hospital-based outpatient services.
• In-depth knowledge of CPT/HCPCS coding.
• In-depth knowledge of APC payment methodologies.
• In-depth knowledge of outpatient regulatory guidelines.
• Experience auditing UB-04 facility claims only.

Nice To Haves

• Certified Outpatient Facility Auditor.

Responsibilities

• Analyze APC groupings, status indicators, payment logic, and CMS OPPS compliance across infusion services, outpatient surgeries, and interventional radiology.
• Audit UB-04 facility claims only.
• Ensure accurate APC assignment.
• Ensure proper packaging.
• Ensure compliant facility billing.

Benefits

• Salary Range: $70,000 – $90,000 (based on experience, skills, and qualifications)
• 100% Remote (U.S.-based)
• Up to 10% annual travel (for team meetings and limited client onsite engagements.)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed