Outpatient Auditor III

ExlService Holdings, Inc.; Northern (KY); Hybrid; USD 70,000 - 90,000; Full time

Job summary

EXL Health seeks a Remote Certified Outpatient Facility Auditor with strong APC reimbursement expertise to audit hospital outpatient facility claims and ensure proper APC assignment.

Role focuses on 100% remote work for U.S.-based claims, with up to 10% travel for meetings and limited client onsite engagements. A coding/auditing assessment may be included in the interview process.

Qualifications

• Strong CPT/HCPCS coding knowledge for facility-based services.
• Expertise in APC payment methodologies and OPPS guidelines.
• Experience auditing UB-04 facility claims for outpatient services.

Responsibilities

• Audit outpatient facility claims to ensure correct APC assignment and packaging.
• Apply CMS OPPS rules and coding guidelines to infusion, surgery, and radiology claims.

Skills

CPT/HCPCS coding

APC reimbursement

CMS OPPS knowledge

UB-04 facility claims auditing

Job description

Are you an experienced Outpatient Facility Auditor with strong APC reimbursement expertise in hospital-based outpatient services? Do you enjoy analyzing APC groupings, status indicators, payment logic, and CMS OPPS compliance across infusion services, outpatient surgeries, and interventional radiology?

EXL Health is seeking a highly skilled auditor to join our growing remote outpatient auditing team, where your work will focus exclusively on facility‑based outpatient claims and APC reimbursement. This role 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.

Salary Range: $70,000 – $90,000 (based on experience, skills, and qualifications)
Location: 100% Remote (U.S.-based)

Up to 10% annual travel (for team meetings and limited client onsite engagements.)

A brief coding/auditing assessment may be included as part of the interview process