About US:
We are a company that provides innovative, transformative IT services and solutions. We are passionate about helping our clients achieve their goals and exceed their expectations. We strive to provide the best possible experience for our clients and employees. We are committed to continuous improvement and innovation, and we are always looking for ways to improve our services and solutions. We believe in working
collaboratively
with our clients and employees to achieve success.
DS Technologies Inc is looking for
Certified Outpatient Surgical Auditor III
role
for one of our premier clients.
Job Title: Certified Outpatient Surgical Auditor III
Location: Pittsburgh, Pennsylvania, US/ C56 (Work From Home)
Job Role: Auditors-Surgery
Position Type: Full Time
Only W2
Job Description:
As a
Remote Certified Outpatient Surgical Auditor
, you’ll bring your
expert knowledge of outpatient coding
,
CPT coding guidelines
, and
reimbursement methodologies
to audit outpatient and professional fee medical records. Your work will directly contribute to validating or revising the provider’s billed
CPT codes
and ensuring claims are accurate, fair, and compliant.
This exciting opportunity allows you to work from home, with occasional travel, and be a key player in driving
excellence
in the healthcare coding industry!
Responsibilities:
Conduct CPT and Ambulatory Payment Classification (APC) reviews
to verify the accuracy of CPT coding and APC reimbursement for outpatient and professional claims.
Apply
Medicare
,
NCCI
, and other coding guidelines to a wide range of claims and use both
industry tools
and
EXL proprietary tools
to identify potential overpayments.
Document audit findings and rationales clearly and professionally, utilizing
AHA Coding Clinic
and
CPT coding rules
.
Leverage proprietary workflow systems and encoder tools (
3M
,
Webstrat
,
Optum Encoder
) to make accurate audit determinations and effectively move claims through the workflow.
Meet or exceed
EXL's productivity and quality goals
, ensuring timely and accurate audit results.
Stay up-to-date on coding guideline changes and reimbursement trends, and apply this knowledge to improve audit outcomes.
Maintain compliance
with EXL’s policies and procedures, including
HIPAA
and other state and federal regulations.
Qualifications
Required:
One or more of the following credentials:
Certified Coding Specialist (CCS)
Registered Health Information Administrator (RHIA)
Registered Health Information Technician (RHIT)
Certified Professional Coder (CPC)
Preference given to candidates with multiple credentials
3+ years of
professional and hospital outpatient coding experience
, including expertise in
AHA
and
CPT Coding Guidelines
and
APC reimbursement methodologies
.
Familiarity with
healthcare payer contract language
.
Preferred:
Experience with
APC retrospective overpayment identification
in specialties like
surgical, radiology
, etc.
Superior knowledge of
CPT coding
,
Official Coding Guidelines
,
Coding Clinic Guidance
, and
National Correct Coding Initiative (NCCI)
guidelines.
Experience using
encoder tools
such as
3M
,
Webstrat
, and
Optum Encoder
.
Ability to work
independently in a remote environment
while delivering exceptional results during
EXL’s core business hours
.
Excellent
time management
skills and ability to prioritize work.
Strong
analytical
,
written
, and
verbal communication
skills.
Proficiency in
Excel
,
Word
, and
OneNote
with a general understanding of computer systems.
What We Offer:
At
EXL Health
, we provide an exciting and innovative environment where
healthcare professionals
come together to influence business decisions and contribute to improving the healthcare industry. Here’s what you can expect:
Collaborative environment
: Work alongside
world-class healthcare consultants
and be a part of a supportive team that values your input.
Career growth
: Learn new skills and gain exposure to different aspects of business operations while working in a fast-paced and engaging environment.
Mentoring program
: Receive guidance from experienced mentors who will help you develop professionally and provide career insights.
Professional development
: We encourage continuous growth and provide opportunities for you to excel within
EXL Health
and beyond.
Work-life balance
: Enjoy the flexibility of a
remote work-from-home position
, with occasional travel to expand your professional network.
At
EXL Health
, the
sky's the limit
for your professional growth. Join us and be a part of a company that values
teamwork
,
excellence
,
collaboration
, and
support
.
Ready to join an exciting team and make an impact in the healthcare industry?
Apply now
and start your journey with
EXL Health
!
Required Skills:
Ambulatory Payment Classification (APC)
American Hospital Association (AHA)
CPT Coding Guidelines
Certified Coding Specialist (CCS)
Certified Professional Coder (CPC)
National Correct Coding Initiative (NCCI)
Registered Health Information Administrator (RHIA)
Registered Health Information Technician (RHIT)
This is a remote position.
Compensation: $70,000.00 - $80,000.00 per year
We are an equal opportunity employer and all qualified applicants will receive
consideration for employment without regard to race, color, religion, sex,
national origin, disability status, protected veteran status, or any other
characteristic protected by law.