What are the responsibilities and job description for the Auditor III - Outpatient position at EXL Services?
Company Overview and Culture
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 55,000 employees spanning six continents. For more information, visit http://www.exlservice.com.
About EXL Health
We leverage Human Ingenuity and domain expertise to help clients improve outcomes, optimize revenue and maximize profitability across the healthcare ecosystem. Technology, data and analytics are at the heart of our solutions. We collaborate closely with clients to transform how care is delivered, managed and paid.
EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Leveraging Human Ingenuity, we collaborate with our clients to solve complex problems and enhance their performance with nimble, scalable solutions. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem.
We help payers improve member care quality and network performance, manage population risk, and optimize revenue while decreasing administrative waste and reducing health claim expenditures. We help Pharmacy Benefit Managers (PBMs) manage member drug benefits and reduce drug spending while maintaining quality. We help provider organizations proactively manage risk, improve outcomes, and optimize network performance. We provide Life Sciences companies with enriched data, insights through advanced analytics and data visualization tools to get the right treatment to the right patient at the right time.
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:
To view our total rewards offered click here — > https://www.exlservice.com/us-careers-and-benefits
Base Salary Range Disclaimer: The base salary range represents the low and high end of the EXL base salary range for this position. Actual salaries will vary depending on factors including but not limited to: location and experience. The base salary range listed is just one component of EXL's total compensation package for employees. Other rewards may include bonuses, as well as a Paid Time Off policy, and many region specific benefits.
Please also note that the data shared through the job application will be stored and processed by EXL in accordance with the EXL Privacy Policy.
Application & Interview Impersonation Warning – Purposely impersonating another individual when applying and / or participating in an interview in order to obtain employment with EXL Service Holdings, Inc. (the “Company”) for yourself or for the other individual is a crime. We have implemented measures to deter and to uncover such unlawful conduct. If the Company identifies such fraudulent conduct, it will result in, as applicable, the application being rejected, an offer (if made) being rescinded, or termination of employment as well as possible legal action against the impersonator(s).
EXL may use artificial intelligence to create insights on how your candidate information matches the requirements of the job for which you applied. While AI may be used in the recruiting process, all final decisions in the recruiting and hiring process will be taken by the recruiting and hiring teams after considering a candidate’s full profile. As a candidate, you can choose to opt out of this artificial intelligence screening process. Your decision to opt out will not negatively impact your opportunity for employment with EXL.
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 55,000 employees spanning six continents. For more information, visit http://www.exlservice.com.
About EXL Health
We leverage Human Ingenuity and domain expertise to help clients improve outcomes, optimize revenue and maximize profitability across the healthcare ecosystem. Technology, data and analytics are at the heart of our solutions. We collaborate closely with clients to transform how care is delivered, managed and paid.
EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Leveraging Human Ingenuity, we collaborate with our clients to solve complex problems and enhance their performance with nimble, scalable solutions. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem.
We help payers improve member care quality and network performance, manage population risk, and optimize revenue while decreasing administrative waste and reducing health claim expenditures. We help Pharmacy Benefit Managers (PBMs) manage member drug benefits and reduce drug spending while maintaining quality. We help provider organizations proactively manage risk, improve outcomes, and optimize network performance. We provide Life Sciences companies with enriched data, insights through advanced analytics and data visualization tools to get the right treatment to the right patient at the right time.
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.
- 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)
- Active AHIMA CCS, RHIT or RHIA
- 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.
- 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.
To view our total rewards offered click here — > https://www.exlservice.com/us-careers-and-benefits
Base Salary Range Disclaimer: The base salary range represents the low and high end of the EXL base salary range for this position. Actual salaries will vary depending on factors including but not limited to: location and experience. The base salary range listed is just one component of EXL's total compensation package for employees. Other rewards may include bonuses, as well as a Paid Time Off policy, and many region specific benefits.
Please also note that the data shared through the job application will be stored and processed by EXL in accordance with the EXL Privacy Policy.
Application & Interview Impersonation Warning – Purposely impersonating another individual when applying and / or participating in an interview in order to obtain employment with EXL Service Holdings, Inc. (the “Company”) for yourself or for the other individual is a crime. We have implemented measures to deter and to uncover such unlawful conduct. If the Company identifies such fraudulent conduct, it will result in, as applicable, the application being rejected, an offer (if made) being rescinded, or termination of employment as well as possible legal action against the impersonator(s).
EXL may use artificial intelligence to create insights on how your candidate information matches the requirements of the job for which you applied. While AI may be used in the recruiting process, all final decisions in the recruiting and hiring process will be taken by the recruiting and hiring teams after considering a candidate’s full profile. As a candidate, you can choose to opt out of this artificial intelligence screening process. Your decision to opt out will not negatively impact your opportunity for employment with EXL.
