Auditor III - Outpatient

EXL was founded on the core values of innovation, collaboration, excellence, integrity, and respect. We are looking for a Sr. Outpatient Auditor to work 100% remotely from home!   Are you a mastery level experienced Managed Care Commercial Outpatient Facility Auditor looking for the next step in your career path?  Is it time for a change? Explore this opportunity with a new, exciting, and dynamic growth-oriented team.   The successful candidate will be passionate, quality focused and retain a 98% or greater accuracy rating. Possess expert level skillset in ICD-10-PCS/CM, CPT and HCPCS Coding Guidelines. Mastery level understanding of Outpatient reimbursement methodologies, along with staying current with CMS changes related to OPPS.   Job Responsibilities:   Will perform post-payment reviews of the medical record to validate the accuracy of the charges billed and determine if a discrepancy exists based on both documentation and medical standards. Must be able to perform comprehensive post-payment reviews of client accounts to determine if correct payments were made to providers in compliance with coding guidelines and payer requirements. Must have the ability to audit a wide variety of complex Outpatient Facility services including, but not limited to: Interventional Radiology, a wide variety of Ambulatory Surgeries, Cardiac Cath, Implants, Injections and Infusions, Emergency Room and Observation including carve-outs. Must have thorough working knowledge of Outpatient payment methodologies including Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Payment Classification (APC) with preferred exposure to Enhanced Ambulatory Patient Grouping (EAPG) System. Expert knowledge of NCCI Guidelines, including the appropriate use and application of coding modifiers, CPT/HCPCs and ICD-10 Coding Systems. Must have a sound knowledge of ICD-10-PCS/CM, CPT and HCPCs Coding Guidelines. Must be proficient with Medicare Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs). Must have the ability to write a professional finding note based on official CPT and HCPCs coding guidelines, CPT Assistant, AHA Coding Clinic, and/or other industry standard resources. Ability to work independently. Meet or exceed program productivity and quality goals. Perform other duties as assigned.   Qualifications:   5-7 years of experience with Outpatient Facility Coding/Auditing Strong Outpatient Surgery and Observation Coding/Auditing experience Sound knowledge of ICD-10-PCS/CM, CPT and HCPCs Coding Guidelines Experience performing post payment reimbursement-based audits Expertise with Medicare LCDs and NCDs Expertise with NCCI, OPPS, and APC Guidelines Excellent verbal and written communication skills Strong attention to detail Experience with encoder tools (3M, Webstrat, Optum, Truecode)   Education & Required Certification:   Active AHIMA CCS, RHIT or RHIA   Work Experience Requirements:   Must have 5-7 years of Outpatient Facility experience with expert knowledge of Outpatient reimbursement methodologies, coding guidelines and contract language. Passionate about Outpatient Auditing, and a desire to work in an environment that thrives on teamwork, excellence, collaboration, inclusiveness, and support.   What We Offer:   EXL Health offers an exciting, fast paced and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with highly experienced, world class Healthcare consultants. You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills - key aspects for personal and professional growth We provide guidance/ coaching to every employee through our mentoring program wherein every junior level employee is assigned a senior level professional as advisors. Sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond.

Salary : $65,000 - $85,000