We make sense of data to drive your business forward. #MakeSenseofData #DriveYourBusinessForward #PartnerYourWay
Outpatient Auditor III – Certified
Location
United States
Posted
10 days ago
Salary
$70K - $90K / year
Seniority
Senior
Job Description
Outpatient Auditor III – Certified
EXL
• Apply 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. • Perform detailed hospital outpatient facility audits with a strong focus on APC assignment, payment status indicators, revenue code alignment, and OPPS reimbursement logic. • Review 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 • Audit UB‑04 facility claims to ensure accurate reporting of CPT/HCPCS codes, modifiers, revenue codes, and charge structures that directly impact APC payment. • Conduct 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.
Job Requirements
- 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.
Benefits
- Up to 10% annual travel (for team meetings and limited client onsite engagements.)
- 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.
Related Guides
Related Categories
Related Job Pages
More Auditor Jobs
• The auditor will receive additional training and is then expected to support the American Petroleum Institute (API). • Perform Quality Management Systems (QMS) audits of manufacturing, oil & natural gas service organizations. • Perform technical audits against product specifications, performance criteria, management systems, and contract requirements. • This position will be based at locations within the operational areas when on assignment. Responsibilities will be performed at assigned client locations.
• The auditor will receive additional training and is then expected to support the American Petroleum Institute (API). • Performing Quality Management Systems (QMS) audits of manufacturing, oil & natural gas service organizations. • Performing technical audits against product specifications, performance criteria, management systems, and contract requirements. • This position will be based at locations within the operational areas when on assignment. • Travel to and from audit locations using common transportation. • Some work may be performed in environments subject to hot and cold temperatures. • Climbing vertical ladders of various heights and construction staging of various heights may be necessary.
Junior Government Auditor
CKH GroupCPA-led assurance, tax, accounting, and advisory firm with offices across the world.
Role Description We are seeking a motivated and detail-oriented Junior Government Auditor to join our Governmental Audit team. This position provides an excellent opportunity for recent graduates or early-career professionals to gain experience performing financial, compliance, and operational audits for local governments, authorities, and nonprofit organizations. The Junior Government Auditor will assist with audit fieldwork, preparation of workpapers, testing of internal controls, and financial statement preparation in accordance with Generally Accepted Government Auditing Standards (GAGAS), Governmental Accounting Standards Board (GASB) requirements, and federal and state compliance requirements. This role offers hands-on experience, mentorship, and professional development opportunities within a growing governmental audit practice. - Assist in performing financial and compliance audits for governmental entities and nonprofit organizations - Prepare audit workpapers and supporting documentation - Perform testing of internal controls and compliance requirements - Assist with analytical procedures and account reconciliations - Review client accounting records and supporting schedules - Assist in drafting audit findings, reports, and management comments - Prepare portions of financial statements and note disclosures - Communicate with clients to obtain requested documentation and explanations - Learn and apply GASB standards, Uniform Guidance requirements, and Government Auditing Standards - Participate in team meetings, training, and continuing professional education opportunities - Travel to client locations as needed Qualifications - Bachelor's degree in Accounting, Finance, or related field - 0–2 years of accounting or audit experience - Basic understanding of accounting principles and financial reporting - Proficiency in Microsoft Excel and Microsoft Office Suite - Strong analytical, organizational, and communication skills - Ability to manage multiple assignments and meet deadlines - Willingness to learn governmental accounting and auditing standards Requirements - Internship or prior experience in public accounting or auditing - Familiarity with GASB standards or Yellow Book auditing - CPA eligibility or plans to pursue CPA certification Benefits - Competitive salary and benefits package - Mentorship and on-the-job training - Exposure to a variety of governmental and nonprofit clients - Opportunities for career growth and advancement - Collaborative and team-oriented work environment - Occasional travel to client sites
The role of Casualty Auditor will encompass the development, planning, execution, and reporting of technical and data quality audits across the business unit. Casualty audits will be undertaken in accordance with internal audit policy and procedure and client requirements.**The role will involve interface with the business across Casualty and interface with Davies operational and support functions as required. It will require analysing data and claims information, identifying risks, and making recommendations for claims improvements across the business unit.**It is important that the auditor has an interest in improving Casualty quality and good attention to detail. They will have a responsibility to drive the Casualty processes and data quality in line with client guidelines and SLA requirements.



