Auditor III - Outpatient

EXL Company is looking for an Auditor III – Outpatient. This is a full-time, work from home opportunity.

In this fully remote position as an Outpatient Auditor you will apply your expert knowledge of outpatient coding and reimbursement and CPT coding guidelines in the auditing of outpatient and professional fee medical records to validate or revise the provider's billed CPT codes.  You will utilize industry and EXL proprietary tools in the CPT assignment process, and will write professional communications documenting audit findings and supporting rationales. You will also apply your extensive coding and industry knowledge to identify audit trends and opportunities.

Key Responsibilities:

• Conduct CPT/APC coding reviews to verify the accuracy of the CPT coding assignment and APC reimbursement on outpatient and professional claims.
• Apply Medicare, NCCI and other coding guidelines to a variety of claim scenarios and effectively utilize industry and proprietary tools to maximize overpayment identifications.
• Document audit results in a clear, concise, and effective manner using AHA Coding Clinic Guidelines and CPT coding rules and guidelines.
• Utilize proprietary workflow systems and encoder tools (e.g., 3M, Webstrat, Optum Encoder etc.) efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly.
• Meet or exceed EXL established program productivity and quality goals, including uphold rate for appeals.
• Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements.
• Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.

Qualifications:

• Required one or more of the following credentials: CCS, RHIA, RHIT, CPC;  preference given to those with multiple credentials
• 3+ years of professional and hospital outpatient coding with expert knowledge of AHA and CPT Coding Guidelines, APC reimbursement methodologies, and familiarity with HealthCare payer contract language.
• Prefer candidate with prior APC retrospective overpayment identification auditing experience.      

Knowledge and Skills:

• Superior knowledge of CPT coding, Official Guidelines for Coding and Reporting and Coding Clinic Guidance, NCCI coding guidelines coupled with APC payment methodologies including Medicare Outpatient Prospective Payment System (OPPS)
• Experience with encoder tools (3M, Webstrat, Optum Encoder).
• Works independently in a remote environment and delivers exceptional results during EXL core business hours.
• Possesses excellent time management and work prioritization skills.
• Takes ownership of problem solving.
• Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail.
• Proficient in Excel, Word, and OneNote with general computer literacy.
• Passionate about Outpatient Auditing with a desire to work in an environment thriving on teamwork, excellence, collaboration, inclusiveness, and support.