Outpatient Auditor II

Are you an experienced Outpatient Auditor with a strong background in infusion services, complex surgery, interventional radiology, and hospital-based care? Do you take pride in ensuring coding accuracy, compliance, and fair reimbursement? If so, we invite you to join our remote auditing team at EXL Health!

As a Remote Certified Outpatient Auditor, you’ll leverage your deep knowledge of CPT coding, outpatient guidelines, and APC reimbursement to audit outpatient and professional fee records across a wide range of specialties. Your expertise will directly support providers, payers, and patients by validating billed CPT codes, identifying discrepancies, and ensuring compliance with coding regulations.

This role offers a fully remote work environment with up to 10% travel annually for team meetings or client engagements.

Key Responsibilities

• Perform detailed audits of outpatient and professional fee claims across infusion, surgical, interventional radiology, and hospital outpatient services.
• Review CPT/HCPCS, APC, and revenue codes to confirm accurate reporting and reimbursement.
• Apply Medicare, NCCI, CPT, and AHA Coding Clinic guidelines to ensure coding compliance.
• Identify and document overpayments, discrepancies, or missed billing opportunities.
• Utilize encoder tools (3M, Webstrat, Optum Encoder) and EXL proprietary systems to review, validate, and process claims efficiently.
• Produce clear, concise audit findings and rationales that align with official coding guidelines.
• Stay current on regulatory updates, outpatient reimbursement changes, and clinical practice trends in infusion, surgery, and radiology.
• Meet and exceed EXL productivity and quality benchmarks while maintaining accuracy and compliance.

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

• Hands-on experience auditing complex outpatient surgical and interventional cases.
• Advanced knowledge of infusion and injection billing guidelines.
• Experience with retrospective overpayment identification in hospital and professional outpatient claims.
• Encoder experience (3M, Webstrat, Optum Encoder).
• Ability to work independently in a remote environment and manage competing priorities.
• Strong written, verbal, and analytical communication skills.
• Proficiency in Microsoft Excel, Word, and OneNote with general computer literacy.

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

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 fi