{"id":3236343,"url":"https://alion.io/job/exl-outpatient-auditor-iii-2","title":"Outpatient Auditor III","company":{"id":38016,"name":"EXL","domain":"exlservice.com","url":"https://alion.io/company/exl","size_band":"5000+","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Oracle","truth_index":{"grade":"B","score":80,"open_postings":269,"ghost_share":0,"stale_share":0.996,"repost_share":0.004,"time_to_fill_p50_days":15,"computed_at":"2026-10-29T05:49:05Z"}},"role":"Finance","role_family":"Finance","seniority":"middle","employment_type":null,"work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"posting_text","remote_working_hours":null,"hiring_geo_confidence":"explicit","locations":[],"countries":[],"hiring_countries":["US"],"hiring_countries_total":1,"salary":{"min":70000,"max":90000,"currency":"USD","period":"year","gross":null,"usd_annual":90000},"salary_estimate":null,"experience_years_min":3,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Microsoft Excel","optional":false}],"status":"live","first_seen_at":"2026-09-02T18:04:48Z","employer_posted_date":"2026-09-02","last_verified_at":"2026-10-29T19:47:40Z","board_verified":true,"closed_at":null,"days_open":57,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":57},"description":"Are you an experienced Outpatient Facility Auditor with strong APC reimbursement expertise in hospital-based outpatient services? Do you enjoy analyzing APC groupings, status indicators, payment logic, and CMS OPPS compliance across infusion services, outpatient surgeries, and interventional radiology?\nEXL Health is seeking a highly skilled auditor to join our growing remote outpatient auditing team, where your work will focus exclusively on facility-based outpatient claims and APC reimbursement. This role is ideal for auditors who specialize in hospital outpatient facility coding and reimbursement.\nAs a Remote Certified Outpatient Facility Auditor, you will apply your in-depth knowledge of CPT/HCPCS coding, APC payment methodologies, and outpatient regulatory guidelines to audit UB-04 facility claims only, ensuring accurate APC assignment, proper packaging, and compliant facility billing.\nSalary Range: $70,000 - $90,000 (based on experience, skills, and qualifications)\nLocation: 100% Remote (U.S.-based)\nUp to 10% annual travel (for team meetings and limited client onsite engagements.)\nA brief coding/auditing assessment may be included as part of the interview process\n Perform detailed hospital outpatient facility audits with a strong focus on APC assignment, payment status indicators, revenue code alignment, and OPPS reimbursement logic.\nReview outpatient claims to validate correct CPT/HCPCS-to-APC mapping, including appropriate assignment of: - Significant procedure APCs vs. packaged services - Comprehensive APCs (C-APCs) - Composite APCs where applicable\n Audit UB-04 facility claims to ensure accurate reporting of CPT/HCPCS codes, modifiers, revenue codes, and charge structures that directly impact APC payment.\nEvaluate APC packaging rules, including bundled payment of: - Ancillary services - Supplies and minor procedures - Drug administration services packaged into primary procedures\nConduct audits across infusion therapy, outpatient surgeries, imaging, and interventional radiology, such as: - Verifying correct APC assignment for chemotherapy and non-chemotherapy infusions, hydration services, and observation-related services - Reviewing outpatient surgical encounters to ensure correct APC selection based on procedure complexity and status indicators - Auditing interventional radiology encounters to confirm appropriate APC grouping and compliance with bundling rules\nValidate proper billing of technical components, including nursing services, equipment usage, supplies, imaging contrast, and facility resources tied to APC reimbursement.\nEnsure facility billing is independent from professional claims, with APC reimbursement evaluated separately from physician payment.\nApply CMS OPPS regulations, CPT rules, NCCI edits, and AHA Coding Clinic guidance to support compliant APC reimbursement.\nIdentify overpayments, underpayments, misassigned APCs, inappropriate unbundling, and missed reimbursement opportunities.\nUtilize encoder and audit tools (3M, Webstrat, Optum Encoder) as well as EXL proprietary systems to analyze APC payment outcomes.\nProduce clear, defensible audit findings that articulate APC-related reimbursement impacts and compliance risks.\nStay current on annual APC updates, OPPS rule changes, CMS transmittals, and payment indicator revisions.\nMeet or exceed EXL productivity, quality, and compliance standards.\n Required\nActive credential(s) such as:o CCS\no RHIA\no RHIT\no CPC\n(Multiple credentials strongly preferred)\n\nMinimum 3 years of hospital outpatient facility coding and/or auditing experience, with direct exposure to APC-driven reimbursement.\nDemonstrated expertise in:- APC payment methodologies\n- OPPS reimbursement logic\n- CPT/HCPCS coding impact on APC assignment\n- UB-04 facility billing requirements\n\nHands-on experience auditing infusion services, outpatient surgeries, and interventional radiology, including APC packaging and bundling scenarios.\nStrong understanding of payer contracts, claim adjudication, and reimbursement variance analysis.\nPreferred\nAdvanced experience auditing complex APC encounters, including comprehensive and composite APC scenarios.\nIn-depth knowledge of infusion and injection coding, including drug status indicators and packaged vs. paid drugs.\nExperience identifying retrospective overpayments tied to APC misassignment or improper unbundling.\nProficiency with 3M, Webstrat, Optum Encoder, or similar tools.\nAbility to work independently in a high-volume remote audit environment.\nStrong written, verbal, and analytical communication skills, especially in explaining APC payment logic.\nProficiency in Microsoft Excel, Word, OneNote, and related applications.\nWhat We Offer\nJoin a high-performing team at EXL Health, where APC expertise, audit precision, and regulatory compliance are actively valued.\nCollaborative environment: Work with experienced outpatient and APC-focused auditors.\nOngoing professional development: Stay ahead of APC and OPPS regulatory changes.\nMentorship & career growth: Learn from senior auditors and advance your outpatient auditing career.\nWork-life balance: Enjoy remote flexibility with limited travel.\nYour APC expertise drives reimbursement accuracy and compliance.\nJoin EXL Health to strengthen outpatient reimbursement integrity and make a measurable impact across the healthcare industry.\nApply today to begin your journey with EXL Health!\nFor more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits\nThe posted base salary range is the hiring base salary range for this role. 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