Auditor I - Outpatient

EXL Company is looking for an Auditor I – Outpatient. This is a Remote Home Office opportunity for the right candidate.

In this fully remote position as a new graduate, you will have the opportunity to develop your skills in auditing and compliance while working with a talented team.  The successful candidate will review outpatient medical records to ensure compliance with regulatory requirements, payer guidelines, and organizational policies. 

Key Responsibilities:

• Conduct thorough CPT/APC coding reviews to verify the accuracy of the CPT coding assignment and APC reimbursement.
• Apply knowledge of Medicare, NCCI and other coding guidelines to a variety of claim scenarios and effectively utilize industry and proprietary tools to maximize overpayment identifications.
• Document audit results in a clear, concise, and effective manner using AHA Coding Clinic Guidelines and CPT coding rules and guidelines.
• Utilize proprietary workflow systems and encoder tools (e.g., 3M, Webstrat, Optum Encoder etc.) efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly.
• Meet or exceed EXL established program productivity and quality goals, including uphold rate for appeals.
• Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements.
• •Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.

Qualifications:

• Required one or more of the following credentials: CCS, RHIA, RHIT, CPC 
• Associates degree or 1 year of experience
• Knowledge of coding guidelines

Knowledge and Skills:

• Knowledge of CPT coding, Official Guidelines for Coding and Reporting and Coding Clinic Guidance, NCCI coding guidelines coupled with APC payment methodologies including Medicare Outpatient Prospective Payment System (OPPS)
• Experience with encoder tools (3M, Webstrat, Optum Encoder).
• Works independently in a remote environment and delivers exceptional results during EXL core business hours.
• Possesses excellent time management and work prioritization skills.
• Takes ownership of problem solving.
• Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail.
• Proficient in Excel, Word, and OneNote with general computer literacy.
• Passionate about Outpatient Auditing with a desire to work in an environment thriving 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.
• Benefits we offer are Healthcare, Vision, Dental and 401k options.