Referso Jobs

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, including appropriate assignment of Significant procedure APCs vs. packaged services, Comprehensive APCs (C-APCs), and Composite APCs.
Audit UB‑04 facility claims to ensure accurate reporting of CPT/HCPCS codes, modifiers, revenue codes, and charge structures.
Evaluate APC packaging rules, including bundled payment of ancillary services, supplies, minor procedures, and drug administration services.
Conduct audits across infusion therapy, outpatient surgeries, imaging, and interventional radiology.

Outpatient Auditor III