Outpatient Auditor Manager

EXL•United States,

1d•$105,000 - $115,000•Remote

About The Position

The role directly manages auditors responsible for outpatient payment integrity reviews, including outpatient facility, ambulatory surgery, emergency department, observation, and professional claim audits. The ideal candidate demonstrates strong leadership and analytical skills, along with expertise in CPT, HCPCS, NCCI edits, CMS outpatient reimbursement methodologies, and payer-specific billing requirements.

Requirements

Lead the execution and continuous improvement of outpatient audit programs.
Oversee day-to-day audit operations to ensure alignment with client SLAs, quality standards, productivity goals, and turnaround requirements.
Manage inventory, workflow distribution, aging, and throughput to support timely completion of audits.
Provide direct supervision, coaching, feedback, and development for outpatient auditors and team leads.
Monitor productivity, quality, and turnaround metrics and implement corrective actions when needed.
Ensure audits are conducted in accordance with CMS regulations, NCCI guidelines, payer policies, and applicable coding and billing requirements.
Support implementation of new clients, audit opportunities, workflow changes, and system enhancements.
Conduct quality reviews and identify trends requiring education, clarification, or process improvement.
Develop and deliver training related to outpatient coding, reimbursement, audit methodologies, and payer requirements.
Identify operational risks, escalate issues appropriately, and support timely resolution.
Prepare and present reporting related to productivity, quality, inventory, aging, and audit outcomes.
Support client meetings, reporting requests, and audit strategy discussions.
Assist with workforce planning, hiring, onboarding, performance management, and talent development.
Five to eight years of experience in outpatient coding, auditing, payment integrity, revenue cycle, or healthcare reimbursement operations.
Strong knowledge of CPT, HCPCS, revenue codes, modifier usage, NCCI edits, APC reimbursement methodologies, and outpatient billing guidelines.
Knowledge of Medicare, Medicaid, and commercial payer policies.
Prior experience leading teams or serving in a supervisory capacity within a production-driven environment.
Experience supporting healthcare audit operations, payment integrity programs, or claims review functions.
Strong analytical and problem-solving skills with the ability to identify trends and support sound operational decisions.
Ability to interpret clinical documentation, coding guidelines, and reimbursement requirements.
Effective written, verbal, and interpersonal communication skills.
Proficiency with Microsoft Office applications and healthcare audit or reporting systems.
Ability to manage audit workflows and team performance to meet operational targets.
Strong understanding of outpatient coding, reimbursement, payment integrity, quality, and audit accuracy standards.
Ability to analyze data, identify risks and trends, and develop practical action plans.
Strong leadership, coaching, and team development skills.
Effective collaboration across clinical, coding, operational, client-facing, and technical teams.
Ability to support process improvements, workflow enhancements, and program implementations.
Strong organizational, prioritization, and time management skills.
Ability to build relationships and maintain positive team and client interactions.

Nice To Haves

RHIT, RHIA, CCS, CPC, COC, or an equivalent coding credential preferred.

Responsibilities

Lead the execution and continuous improvement of outpatient audit programs.
Oversee day-to-day audit operations to ensure alignment with client SLAs, quality standards, productivity goals, and turnaround requirements.
Manage inventory, workflow distribution, aging, and throughput to support timely completion of audits.
Provide direct supervision, coaching, feedback, and development for outpatient auditors and team leads.
Monitor productivity, quality, and turnaround metrics and implement corrective actions when needed.
Ensure audits are conducted in accordance with CMS regulations, NCCI guidelines, payer policies, and applicable coding and billing requirements.
Support implementation of new clients, audit opportunities, workflow changes, and system enhancements.
Conduct quality reviews and identify trends requiring education, clarification, or process improvement.
Develop and deliver training related to outpatient coding, reimbursement, audit methodologies, and payer requirements.
Identify operational risks, escalate issues appropriately, and support timely resolution.
Prepare and present reporting related to productivity, quality, inventory, aging, and audit outcomes.
Support client meetings, reporting requests, and audit strategy discussions.
Assist with workforce planning, hiring, onboarding, performance management, and talent development.