Outpatient Auditor III

EXL

. Perform detailed hospital outpatient facility audits focused on APC assignment, payment status indicators, revenue code alignment, and OPPS reimbursement logic .

Posted 11/5/2026full-timeRemote • United StatesMid-LevelSenior💰 $70,000 - $90,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in hospital outpatient facility auditing, focusing on APC assignment, OPPS reimbursement logic, and CPT/HCPCS coding. Proficient in utilizing auditing tools and maintaining compliance with CMS regulations and payer contracts.

Highest-signal resume keywords

APC Payment MethodologiesCPT/HCPCS CodingUB-04 Facility BillingInfusion Services Auditing3M, Webstrat, Optum Encoder

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

APC AssignmentOPPS Reimbursement LogicCPT/HCPCS CodingRevenue Code AlignmentAudit UB-04 ClaimsInfusion Therapy AuditingInterventional Radiology AuditingOverpayment IdentificationReimbursement Variance AnalysisAPC Packaging Rules

Soft Skills

Analytical CommunicationWritten CommunicationVerbal CommunicationIndependent WorkAttention to Detail

Tools & Technologies

3MWebstratOptum EncoderEXL Proprietary SystemsMicrosoft ExcelMicrosoft WordMicrosoft OneNote

Certifications & Qualifications

CCSRHIARHITCPC

Industry Keywords

Hospital Outpatient Facility AuditingAPC-Driven ReimbursementCMS OPPS RegulationsNCCI EditsAHA Coding Clinic Guidance

About the role

Key responsibilities & impact

Perform detailed hospital outpatient facility audits focused on APC assignment, payment status indicators, revenue code alignment, and OPPS reimbursement logic
Review outpatient claims to validate CPT/HCPCS-to-APC mapping, including significant procedure, packaged, comprehensive, and composite APCs
Audit UB-04 facility claims for accurate CPT/HCPCS codes, modifiers, revenue codes, and charge structures
Evaluate APC packaging rules for ancillary services, supplies, minor procedures, and drug administration services
Audit infusion therapy, outpatient surgeries, imaging, and interventional radiology encounters
Validate billing of technical components including nursing services, equipment, supplies, imaging contrast, and facility resources
Evaluate APC reimbursement separately from physician payment
Apply CMS OPPS regulations, CPT rules, NCCI edits, and AHA Coding Clinic guidance
Identify overpayments, underpayments, misassigned APCs, inappropriate unbundling, and missed reimbursement opportunities
Use 3M, Webstrat, Optum Encoder, and EXL proprietary systems to analyze APC payment outcomes
Produce defensible audit findings describing reimbursement impacts and compliance risks
Stay current on APC updates, OPPS rule changes, CMS transmittals, and payment indicator revisions
Meet or exceed EXL productivity, quality, and compliance standards

Requirements

What you’ll need

Active credential(s) such as CCS, RHIA, RHIT, or CPC
Minimum 3 years of hospital outpatient facility coding and/or auditing experience, with direct exposure to APC-driven reimbursement
Expertise in APC payment methodologies, OPPS reimbursement logic, CPT/HCPCS coding impact on APC assignment, and UB-04 facility billing requirements
Hands-on experience auditing infusion services, outpatient surgeries, and interventional radiology, including APC packaging and bundling scenarios
Strong understanding of payer contracts, claim adjudication, and reimbursement variance analysis
Advanced experience auditing complex APC encounters, including comprehensive and composite APC scenarios preferred
In-depth knowledge of infusion and injection coding, including drug status indicators and packaged vs. paid drugs preferred
Experience identifying retrospective overpayments tied to APC misassignment or improper unbundling preferred
Proficiency with 3M, Webstrat, Optum Encoder, or similar tools preferred
Ability to work independently in a high-volume remote audit environment preferred
Strong written, verbal, and analytical communication skills preferred
Proficiency in Microsoft Excel, Word, OneNote, and related applications preferred

Benefits

Comp & perks

Pay for Performance Bonus
Up to 10% annual travel for team meetings and limited client onsite engagements
Collaborative environment with experienced outpatient and APC-focused auditors
Ongoing professional development on APC and OPPS regulatory changes
Mentorship and career growth
Remote flexibility with limited travel