Outpatient Auditor III

EXL•United States,

2d•$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 position is ideal for auditors who 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

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, proper packaging, and compliant facility billing.