• Audit outpatient claims with a focus on APC groupings, revenue codes, CPT bundling rules, and UB‑04 facility coding requirements. • Ensure accurate documentation and coding of technical components such as nursing services, equipment use, and place of service. • Verify that facility charges and resource utilization are coded correctly and independently from provider claims. • Conduct detailed audits across infusion therapy, surgical services, interventional radiology, and other hospital outpatient service lines. • Review CPT, APC, to validate correct reporting and reimbursement. • Apply Medicare regulations, NCCI edits, CPT rules, and AHA Coding Clinic guidance to support compliance. • Identify overpayments, coding discrepancies, and missed reimbursement opportunities. • Utilize encoder tools (3M, Webstrat, Optum Encoder) and EXL proprietary platforms to analyze and process claims. • Produce clear and concise audit findings aligned with official coding rules. • Stay current on outpatient regulatory changes, reimbursement updates, and clinical practice trends across infusion, surgery, and radiology. • Meet or exceed EXL productivity, quality, and compliance standards.