Certified Outpatient Auditor

Job Summary

Working remotely, the Certified Outpatient Auditor will review outpatient claims with a focus on coding accuracy, regulatory compliance, and reimbursement for infusion services, complex surgeries, and interventional radiology, while also ensuring adherence to industry standards.

Key responsibilities

• Audit outpatient claims, focusing on APC groupings, revenue codes, and CPT bundling rules
• Verify accurate documentation and coding of technical components, ensuring independent coding from provider claims
• Identify overpayments and coding discrepancies while producing clear audit findings aligned with official coding rules

Required qualifications

• One or more relevant credentials: CCS, RHIA, RHIT, or CPC
• 3+ years of professional experience in hospital outpatient coding/auditing, including infusion and surgical cases
• Strong knowledge of CPT/HCPCS and APC reimbursement methodologies
• Familiarity with payer contract language and claim adjudication processes
• Proficiency with encoder tools such as 3M, Webstrat, or Optum