Job 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?
EXL 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.
As 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.
Salary Range: $70,000 – $90,000 (based on experience, skills, and qualifications)
Location: 100% Remote (U.S.-based)
✈️ Up to 10% annual travel (for team meetings and limited client onsite engagements.)
A brief coding/auditing assessment may be included as part of the interview process
The posted range is the hiring range for this role — a subset of the broader range available to employees over time — and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.
Qualifications: Required
- Active credential(s) such as:
o CCS
o RHIA
o RHIT
o CPC
(Multiple credentials strongly preferred)
- Minimum 3 years of hospital outpatient facility coding and/or auditing experience, with direct exposure to APC-driven reimbursement.
- Demonstrated expertise in:
– APC payment methodologies
– OPPS reimbursement logic
– CPT/HCPCS coding impact on APC assignment
– UB‑04 facility billing requirements
- Hands-on experience auditing infusion services, outpatient surgeries, and interventional radiology, including APC packaging and bundling scenarios.
- Strong understanding of payer contracts, claim adjudication, and reimbursement variance analysis.
Preferred
- Advanced experience auditing complex APC encounters, including comprehensive and composite APC scenarios.
- In-depth knowledge of infusion and injection coding, including drug status indicators and packaged vs. paid drugs.
- Experience identifying retrospective overpayments tied to APC misassignment or improper unbundling.
- Proficiency with 3M, Webstrat, Optum Encoder, or similar tools.
- Ability to work independently in a high-volume remote audit environment.
- Strong written, verbal, and analytical communication skills, especially in explaining APC payment logic.
- Proficiency in Microsoft Excel, Word, OneNote, and related applications.
What We Offer
Join a high-performing team at EXL Health, where APC expertise, audit precision, and regulatory compliance are actively valued.
- Collaborative environment: Work with experienced outpatient and APC-focused auditors.
- Ongoing professional development: Stay ahead of APC and OPPS regulatory changes.
- Mentorship & career growth: Learn from senior auditors and advance your outpatient auditing career.
- Work-life balance: Enjoy remote flexibility with limited travel.
Your APC expertise drives reimbursement accuracy and compliance.
Join EXL Health to strengthen outpatient reimbursement integrity and make a measurable impact across the healthcare industry.
Apply today to begin your journey with EXL Health!
For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
