Outpatient - Auditor III

EXL Health; United States; Remote; USD 70,000 - 80,000; Full time

Job summary

Join a dynamic remote team as a Certified Outpatient Auditor, where your expertise in outpatient coding and reimbursement methodologies will make a significant impact in the healthcare industry. This role offers the flexibility of working from home while contributing to the accuracy of medical records and ensuring fair reimbursement practices. You'll collaborate with top healthcare professionals, participate in a supportive and innovative environment, and enjoy opportunities for professional growth and development. If you're passionate about healthcare coding and eager to drive excellence in the industry, this is the perfect opportunity for you.

Benefits

Medical insurance

Vision insurance

401(k)

Paid paternity leave

Paid maternity leave

Mentoring program

Career growth opportunities

Work-life balance

Qualifications

• 3+ years of outpatient coding experience with expertise in CPT and AHA guidelines.
• Strong analytical and communication skills for accurate coding and documentation.

Responsibilities

• Conduct audits on outpatient claims to ensure coding accuracy and compliance.
• Document findings and maintain compliance with HIPAA and other regulations.

Skills

CPT coding

outpatient coding

analytical skills

communication skills

time management

Education

Certified Coding Specialist (CCS)

Registered Health Information Administrator (RHIA)

Certified Professional Coder (CPC)

Tools

3M

Webstrat

Optum Encoder

Excel

Word

OneNote

Job description

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This range is provided by EXL Health. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$70,000.00/yr - $80,000.00/yr

Direct message the job poster from EXL Health

Talent Acquisition Recruiting and HR Assistant at EXL Health

Are you a skilled Certified Outpatient Auditor with a passion for ensuring fair reimbursement and maintaining high standards of healthcare coding integrity? If so, we want you to join our dynamic, remote team at EXL Health!

As a Remote Certified Outpatient Auditor, you’ll bring your expert knowledge of outpatient coding, CPT coding guidelines, and reimbursement methodologies to audit outpatient and professional fee medical records. Your work will directly contribute to validating or revising the provider’s billed CPT codes and ensuring claims are accurate, fair, and compliant.

This exciting opportunity allows you to work from home, with occasional travel, and be a key player in driving excellence in the healthcare coding industry!

Key Responsibilities:

• Conduct CPT and Ambulatory Payment Classification (APC) reviews to verify the accuracy of CPT coding and APC reimbursement for outpatient and professional claims.
• Apply Medicare, NCCI, and other coding guidelines to a wide range of claims and use both industry tools and EXL proprietary tools to identify potential overpayments.
• Document audit findings and rationales clearly and professionally, utilizing AHA Coding Clinic and CPT coding rules.
• Leverage proprietary workflow systems and encoder tools (3M, Webstrat, Optum Encoder) to make accurate audit determinations and effectively move claims through the workflow.
• Meet or exceed EXL's productivity and quality goals, ensuring timely and accurate audit results.
• Stay up-to-date on coding guideline changes and reimbursement trends, and apply this knowledge to improve audit outcomes.
• Maintain compliance with EXL’s policies and procedures, including HIPAA and other state and federal regulations.

Qualifications:

Required:

• One or more of the following credentials:
• Certified Coding Specialist (CCS)
• Registered Health Information Administrator (RHIA)
• Certified Professional Coder (CPC)
• Preference given to candidates with multiple credentials
• 3+ years of professional and hospital outpatient coding experience, including expertise in AHA and CPT Coding Guidelines and APC reimbursement methodologies.
• Familiarity with healthcare payer contract language.

Preferred:

• Experience with APC retrospective overpayment identification in specialties like surgical, radiology, etc.
• Superior knowledge of CPT coding, Official Coding Guidelines, Coding Clinic Guidance, and National Correct Coding Initiative (NCCI) guidelines.
• Experience using encoder tools such as 3M, Webstrat, and Optum Encoder.
• Ability to work independently in a remote environment while delivering exceptional results during EXL’s core business hours.
• Excellent time management skills and ability to prioritize work.
• Strong analytical, written, and verbal communication skills.
• Proficiency in Excel, Word, and OneNote with a general understanding of computer systems.

What We Offer:

At EXL Health, we provide an exciting and innovative environment where healthcare professionals come together to influence business decisions and contribute to improving the healthcare industry. Here’s what you can expect:

• Collaborative environment: Work alongside world-class healthcare consultants and be a part of a supportive team that values your input.
• Career growth: Learn new skills and gain exposure to different aspects of business operations while working in a fast-paced and engaging environment.
• Mentoring program: Receive guidance from experienced mentors who will help you develop professionally and provide career insights.
• Professional development: We encourage continuous growth and provide opportunities for you to excel within EXL Health and beyond.
• Work-life balance: Enjoy the flexibility of a remote work-from-home position, with occasional travel to expand your professional network.

At EXL Health, the sky's the limit for your professional growth. Join us and be a part of a company that values teamwork, excellence, collaboration, and support.

Ready to join an exciting team and make an impact in the healthcare industry? Apply now and start your journey with EXL Health!

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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Inferred from the description for this job

Medical insurance

Vision insurance

401(k)

Paid paternity leave

Paid maternity leave

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