The role directly manages auditors responsible for outpatient payment integrity
reviews, including outpatient facility, ambulatory surgery, emergency
department, observation, and professional claim audits. The ideal candidate
demonstrates strong leadership and analytical skills, along with expertise in
CPT, HCPCS, NCCI edits, CMS outpatient reimbursement methodologies, and
payer-specific billing requirements.
Salary Range: $105,000 – $115,000 (based on experience, skills, and
qualifications)
Location: 100% Remote (U.S.-based)
Up to 10% annual travel (for team meetings and limited client onsite
engagements.)
A brief coding/auditing assessment may be included as part of the interview
process.
For more information on benefits and what we offer please visit us at US Careers
and Benefits [https://www.exlservice.com/us-careers-and-benefits]
RESPONSIBILITIES
Lead the execution and continuous improvement of outpatient audit programs.
Oversee day-to-day audit operations to ensure alignment with client SLAs,
quality standards, productivity goals, and turnaround requirements.
Manage inventory, workflow distribution, aging, and throughput to support
timely completion of audits.
Provide direct supervision, coaching, feedback, and development for
outpatient auditors and team leads.
Monitor productivity, quality, and turnaround metrics and implement
corrective actions when needed.
Ensure audits are conducted in accordance with CMS regulations, NCCI
guidelines, payer policies, and applicable coding and billing requirements.
Support implementation of new clients, audit opportunities, workflow changes,
and system enhancements.
Conduct quality reviews and identify trends requiring education,
clarification, or process improvement.
Develop and deliver training related to outpatient coding, reimbursement,
audit methodologies, and payer requirements.
Identify operational risks, escalate issues appropriately, and support timely
resolution.
Prepare and present reporting related to productivity, quality, inventory,
aging, and audit outcomes.
Support client meetings, reporting requests, and audit strategy discussions.
Assist with workforce planning, hiring, onboarding, performance management,
and talent development.
QUALIFICATIONS
Lead the execution and continuous improvement of outpatient audit programs.
Oversee day-to-day audit operations to ensure alignment with client SLAs,
quality standards, productivity goals, and turnaround requirements.
Manage inventory, workflow distribution, aging, and throughput to support
timely completion of audits.
Provide direct supervision, coaching, feedback, and development for
outpatient auditors and team leads.
Monitor productivity, quality, and turnaround metrics and implement
corrective actions when needed.
Ensure audits are conducted in accordance with CMS regulations, NCCI
guidelines, payer policies, and applicable coding and billing requirements.
Support implementation of new clients, audit opportunities, workflow changes,
and system enhancements.
Conduct quality reviews and identify trends requiring education,
clarification, or process improvement.
Develop and deliver training related to outpatient coding, reimbursement,
audit methodologies, and payer requirements.
Identify operational risks, escalate issues appropriately, and support timely
resolution.
Prepare and present reporting related to productivity, quality, inventory,
aging, and audit outcomes.
Support client meetings, reporting requests, and audit strategy discussions.
Assist with workforce planning, hiring, onboarding, performance management,
and talent development.
RHIT, RHIA, CCS, CPC, COC, or an equivalent coding credential preferred.
Five to eight years of experience in outpatient coding, auditing, payment
integrity, revenue cycle, or healthcare reimbursement operations.
Strong knowledge of CPT, HCPCS, revenue codes, modifier usage, NCCI edits,
APC reimbursement methodologies, and outpatient billing guidelines.
Knowledge of Medicare, Medicaid, and commercial payer policies.
Prior experience leading teams or serving in a supervisory capacity within a
production-driven environment.
Experience supporting healthcare audit operations, payment integrity
programs, or claims review functions.
Strong analytical and problem-solving skills with the ability to identify
trends and support sound operational decisions.
Ability to interpret clinical documentation, coding guidelines, and
reimbursement requirements.
Effective written, verbal, and interpersonal communication skills.
Proficiency with Microsoft Office applications and healthcare audit or
reporting systems.
Ability to manage audit workflows and team performance to meet operational
targets.
Strong understanding of outpatient coding, reimbursement, payment integrity,
quality, and audit accuracy standards.
Ability to analyze data, identify risks and trends, and develop practical
action plans.
Strong leadership, coaching, and team development skills.
Effective collaboration across clinical, coding, operational, client-facing,
and technical teams.
Ability to support process improvements, workflow enhancements, and program
implementations.
Strong organizational, prioritization, and time management skills.
Ability to build relationships and maintain positive team and client
interactions.
A fast-paced, innovative environment with a team of industry-leading experts.
Hands-on experience supporting leading healthcare clients.
A strong culture of collaboration, support, inclusion, and professional
development.
A competitive benefits package, including healthcare, vision, dental, and
401(k) options.
The posted range is the hiring range for this role — a subset of the broader
range available to employees over time — and reflects base salary across our
national hiring scale. Final offers are based on several factors, including the
candidate's skills and experience, internal pay equity, work location, market
conditions for the role, and the specific scope and responsibilities of the
position. The top of the range is reserved for candidates who notably exceed the
requirements; the lower end applies to those with less experience or fewer
preferred qualifications. For positions based in higher-cost zones (e.g.,
California, New York, New Jersey), actual compensation may exceed the posted
range; your recruiter will share specifics during the process.