Outpatient Auditor II

EXL

. Audit outpatient claims with a focus on APC groupings, revenue codes, CPT bundling rules, and UB-04 facility coding requirements .

Posted 11/6/2026full-timeRemote • United StatesMid-LevelSenior💰 $65,000 - $75,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in outpatient coding and auditing, with a strong focus on CPT/HCPCS, APC reimbursement methodologies, and compliance with Medicare regulations. Proficient in utilizing encoder tools and producing detailed audit findings while managing multiple priorities in a remote environment.

Highest-signal resume keywords

Certified Coding Specialist (CCS)Registered Health Information Administrator (RHIA)Registered Health Information Technician (RHIT)Certified Professional Coder (CPC)3+ Years Outpatient Coding/Auditing Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

CPT/HCPCS CodingAPC Reimbursement MethodologiesInfusion Coding RegulationsSurgical CodingInterventional Radiology CodingOverpayment IdentificationClaim Adjudication ProcessesDocumentation AccuracyAudit Findings Production

Soft Skills

Analytical CommunicationWritten CommunicationVerbal CommunicationIndependent WorkPriority Management

Tools & Technologies

3MWebstratOptum EncoderEXL Proprietary PlatformsMicrosoft ExcelMicrosoft WordMicrosoft OneNote

Certifications & Qualifications

Certified Coding Specialist (CCS)Registered Health Information Administrator (RHIA)Registered Health Information Technician (RHIT)Certified Professional Coder (CPC)

Industry Keywords

Outpatient ClaimsCPT Bundling RulesUB-04 Facility CodingMedicare RegulationsNCCI EditsAHA Coding Clinic GuidanceRevenue CodesResource UtilizationInfusion TherapySurgical Services

About the role

Key responsibilities & impact

Audit outpatient claims with a focus on APC groupings, revenue codes, CPT bundling rules, and UB-04 facility coding requirements
Ensure accurate documentation and coding of technical components such as nursing services, equipment use, and place of service
Verify facility charges and resource utilization independently from provider claims
Conduct detailed audits across infusion therapy, surgical services, interventional radiology, and other hospital outpatient service lines
Review CPT and APC reporting to validate correct reimbursement
Apply Medicare regulations, NCCI edits, CPT rules, and AHA Coding Clinic guidance
Identify overpayments, coding discrepancies, and missed reimbursement opportunities
Use 3M, Webstrat, Optum Encoder, and EXL proprietary platforms to analyze and process claims
Produce clear and concise audit findings aligned with official coding rules
Stay current on outpatient regulatory changes, reimbursement updates, and clinical practice trends
Meet or exceed EXL productivity, quality, and compliance standards

Requirements

What you’ll need

One or more of the following credentials: Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Professional Coder (CPC)
3+ years of professional and hospital outpatient coding/auditing experience, including infusion, surgical, and interventional radiology cases
Strong knowledge of CPT/HCPCS, APC reimbursement methodologies, and official coding guidelines
Familiarity with payer contract language and claim adjudication processes
Experience auditing complex outpatient surgical and interventional radiology cases
Advanced knowledge of infusion and injection coding regulations
Background in retrospective overpayment identification for hospital and professional claims
Proficiency with encoder tools such as 3M, Webstrat, and Optum
Ability to work independently in a remote environment and manage multiple priorities
Strong written, verbal, and analytical communication skills
Proficiency in Microsoft Excel, Word, OneNote, and general computer applications

Benefits

Comp & perks

Collaborative team environment
Professional development and exposure to multiple specialties
Mentorship and growth opportunities
Flexible remote work
Up to 10% annual travel for team meetings and occasional client onsite engagements