Lead remote outpatient facility audits focusing on APC reimbursement, CPT/HCPCS coding, and CMS OPPS compliance.
Salary Range: $70,000 – $90,000 (based on experience, skills, and qualifications)
- 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 and ensure accurate reporting of CPT/HCPCS codes, modifiers, revenue codes, and charge structures.
- Evaluate APC packaging rules and bundled payment scenarios.
- Conduct audits across infusion therapy, outpatient surgeries, imaging, and interventional radiology.
- Validate proper billing of technical components and ensure facility billing is independent from professional claims.
- Nice to have: Advanced APC auditing
- Nice to have: Infusion and injection coding
- Nice to have: Drug status indicators
- Nice to have: Bundled payment analysis
