DS Technologies Inc · 18 hours ago
Outpatient Auditor III
United States
Full-time
Remote
Mid, Senior Level
$70K/yr - $80K/yr
3+ years expDS Technologies Inc is a company that provides innovative, transformative IT services and solutions. They are seeking a Remote Certified Outpatient Auditor to audit outpatient and professional fee medical records, ensuring claims are accurate, fair, and compliant.
Information Technology & Services
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
Qualification
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
Benefits
Collaborative environment
Career growth
Mentoring program
Professional development
Work-life balance
Company
DS Technologies Inc
DS Technologies Inc - SUCCESS IS OUR DUTY At DS Technologies, we’re more than just a technology provider – we’re your strategic partner in navigating the digital revolution.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase