Are you a skilled Outpatient Auditor with deep expertise in infusion services, complex surgeries, interventional radiology, and hospital-based outpatient care? Do you bring a strong commitment to coding accuracy, regulatory compliance, and appropriate reimbursement? If so, EXL Health is excited to welcome you to our remote auditing team!
As a Remote Certified Outpatient Auditor, you’ll apply your in‑depth knowledge of CPT coding, outpatient regulatory guidelines, and APC reimbursement to review outpatient claims across a variety of clinical specialties. Your work will support providers, payers, and patients by validating billed CPT codes, identifying discrepancies, and ensuring adherence to industry standards.
This role is fully remote, with up to 10% annual travel for team meetings and occasional client onsite engagements.
Responsibilities
- 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 that facility charges and resource utilization are coded correctly and independently from provider claims.
- Conduct detailed audits across infusion therapy, surgical services, interventional radiology, and other hospital outpatient service lines.
- Review CPT, APC, to validate correct reporting and reimbursement.
- Apply Medicare regulations, NCCI edits, CPT rules, and AHA Coding Clinic guidance to support compliance.
- Identify overpayments, coding discrepancies, and missed reimbursement opportunities.
- Utilize encoder tools (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 across infusion, surgery, and radiology.
- Meet or exceed EXL productivity, quality, and compliance standards.
Qualifications
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 for multiple credentials
- 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.
Preferred
- 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 (3M, Webstrat, 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.
What We Offer
At EXL Health, you’ll join a team dedicated to excellence, compliance, and innovation in healthcare.
- Collaborative team environment – Work with top-tier healthcare professionals who value your expertise.
- Professional development – Gain exposure to multiple specialties and continue expanding your knowledge base.
- Mentorship & growth opportunities – Learn from senior auditors and leaders while developing your career path.
- Work-life balance – Enjoy the flexibility of remote work with occasional travel to stay connected with colleagues.
At EXL Health, your expertise matters. Join us to make an impact, advance your career, and contribute to the future of healthcare auditing.
Apply now to start your journey with EXL Health!
Pay range for this role is: $65k - $75k
For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
About Company
EXL is the indispensable partner for leading businesses in data-led industries such as insurance, banking and financial services, healthcare, retail and logistics. We bring a unique combination of data, advanced analytics, digital technology and industry expertise to help our clients turn data into insights, streamline operations, improve customer experience, and transform their business. Our partnerships with clients are built on a foundation of collaboration – and we’ve been chosen as a partner by nine of the top ten leading US insurance companies, nine of the top 20 global banks, and six of the top ten US health care payers. We function as one team to make your goals our goals, whether that’s unlocking the value of generative AI or embedding analytics into workflows that reduce risk or power your growth. Clients choose EXL as their transformation partner for many reasons. Our geographic diversity make talent all over the world instantly accessible. Digital accelerators enable unmatched speed-to-value, letting you realize results fast. It’s our people that truly set us apart, though, including the 1,500 data scientists we have dedicated to our generative AI practice. And our more than twenty years of experience in delivering business services, garnering stellar client references, and maintaining a solid balance sheet are reassuring to our C-suite clients. Find out for yourself why clients, employees, and analysts think we’re some of the best in the business. Contact us to see how we can help you achieve your goals.
Company
EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com.
EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL’s Human Resources team, as well as our hiring managers.