Outpatient Auditor III

Role Overview

• 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, ensuring accurate reporting of CPT/HCPCS codes, modifiers, revenue codes, and charge structures that directly impact APC payment.
• Audit UB-04 facility claims to evaluate APC packaging rules, including bundled payment of ancillary services, supplies and minor procedures, and drug administration services packaged into primary procedures.
• Conduct audits across infusion therapy, outpatient surgeries, imaging, and interventional radiology to verify correct APC assignment.

Requirements

• Active credential(s) such as: CCS, RHIA, RHIT, 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.

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.