Inpatient/Outpatient Payment Integrity SME - Part-Time

ExlService Holdings, Inc.; United States; Hybrid; USD 103,000 - 138,000; Part time

Job summary

ExlService Holdings, Inc. is seeking experienced Inpatient and Outpatient Payment Integrity SMEs to support identification of overpayment opportunities and development of new audit concepts.

The role requires deep knowledge of healthcare claims, coding, reimbursement, audit outcomes, and billing patterns across inpatient and outpatient settings, with collaboration across analytics, clinical, coding, operations, and technology teams.

Qualifications

• Experience in inpatient and outpatient payment integrity, identifying overpayments.
• Strong knowledge of healthcare claims, coding, reimbursement, and billing patterns.
• Ability to develop scalable audit concepts and automation strategies.

Responsibilities

• Collaborate with analytics, clinical, coding, operations, and technology teams to translate billing insights into audit concepts.
• Create and optimize business rules and automated selection strategies for payment integrity audits.

Job description

ExlService Holdings, Inc. is seeking experienced Inpatient and Outpatient Payment Integrity SMEs to support identification of overpayment opportunities and development of new audit concepts.

The role requires deep knowledge of healthcare claims, coding, reimbursement, audit outcomes, and billing patterns across inpatient and outpatient settings, with collaboration across analytics, clinical, coding, operations, and technology teams.