Highly skilled remote Outpatient Facility Auditor focusing on facility-based outpatient claims and APC reimbursement, specifically for hospital-based services like infusion, surgeries, and interventional radiology.
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.
- CCS
- RHIA
- RHIT
- CPC
- Nice to have: Advanced experience auditing complex APC encounters
Outpatient Auditor IIEXL · Remote, US