Certified Outpatient Auditor

Job Summary

Skilled in outpatient auditing, the fully remote Certified Outpatient Auditor will apply expertise in CPT coding and regulatory compliance to audit outpatient claims, ensuring accuracy and adherence to industry standards, with up to 10% annual travel for team meetings and client engagements.

Key responsibilities

• Audit outpatient claims focusing on APC groupings, revenue codes, and CPT bundling rules
• Ensure accurate documentation and coding of technical components, including nursing services and equipment use
• Identify overpayments and coding discrepancies while producing clear audit findings aligned with official coding rules

Required qualifications

• One or more of the following credentials: CCS, RHIA, RHIT, CPC
• 3+ years of professional and hospital outpatient coding/auditing experience, including infusion and surgical cases
• Strong knowledge of CPT/HCPCS and APC reimbursement methodologies
• Familiarity with payer contract language and claim adjudication processes