Outpatient Auditor III

About Us

We are a company that provides innovative, transformative IT services and solutions. We are passionate about helping our clients achieve their goals and exceed their expectations. We strive to provide the best possible experience for our clients and employees. We are committed to continuous improvement and innovation, and we are always looking for ways to improve our services and solutions. We believe in working collaboratively with our clients and employees to achieve success.

DS Technologies Inc is looking for Outpatient Auditor III role for one of our premier clients.

Job Title: Outpatient Auditor III

Location: US Pennsylvania (Pittsburgh) C56 (Work From Home)

Job Role: Auditors-HBA

Position Type: W2

Only W2

Experience: 3 to 6 Years

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!

• 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 over payments.
• 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.

Required:

• One or more of the following credentials:
  • Certified Coding Specialist (CCS)
  • Registered Health Information Administrator (RHIA)
  • Registered Health Information Technician (RHIT)
  • 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 over payment 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 One Note with a general understanding of computer systems.

• 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.

• Ambulatory Payment Classification (APC)
• American Hospital Association (AHA)
• CPT Coding Guidelines
• Certified Coding Specialist (CCS)
• Certified Professional Coder (CPC)
• National Correct Coding Initiative (NCCI)
• Registered Health Information Administrator (RHIA)
• Registered Health Information Technician (RHIT)

This is a remote position.