Outpatient Auditor /Surgical Focus/

The Outpatient Auditor is responsible for performing detailed reviews of outpatient surgical and ancillary coding to ensure accuracy, compliance, and appropriate reimbursement. This role supports Sage Clinical RCM’s audit services by identifying documentation deficiencies, coding discrepancies, and revenue opportunities across a variety of facility types. The ideal candidate will have extensive experience in outpatient surgery coding, including same-day surgery, observation, and emergency department encounters. • Key Responsibilities • Conduct detailed retrospective and concurrent audits of outpatient surgical and ancillary encounters. • Review operative reports, clinical documentation, and supporting records to ensure accurate CPT, HCPCS, and ICD-10-CM code assignment. • Validate coding accuracy in accordance with CMS, CPT, ICD-10, OPPS, and facility-specific guidelines. • Identify coding errors, compliance risks, and documentation improvement opportunities. • Prepare clear, well-documented audit findings and deliver summaries to clients and internal leadership. • Collaborate with HIM and education teams to provide feedback and targeted coder training when needed. • Maintain current knowledge of regulatory updates, including NCCI edits, OPPS/APC changes, and CPT Assistant guidance. • Participate in internal quality assurance reviews to ensure consistency and adherence to organizational standards. Requirements Qualifications • Required Certifications: CPC, COC, CIC, or AHIMA equivalent. • Experience: • Minimum 5 years of hospital-based outpatient coding experience. • Minimum 2 years of hospital-based outpatient auditing experience. • Strong knowledge of CPT and ICD-10-CM guidelines for outpatient surgery, observation, and ancillary services. • Familiarity with OPPS/APC reimbursement methodologies. • Excellent written and verbal communication skills. • Ability to work independently, manage multiple audits, and meet deadlines. Preferred Qualifications • Experience with ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). • Experience using audit reporting tools and EHR systems (Epic, Cerner, Meditech). • Familiarity with coding tools such as TruBridge, TruCode, or 3M encoder systems. • Awareness of payer audit trends and compliance requirements. Core Competencies • Strong analytical and detail-oriented approach • High level of integrity and confidentiality • Excellent time management and organizational skills • Commitment to continuous learning and regulatory compliance Original job Outpatient Auditor /Surgical Focus/ posted on GrabJobs ©. To flag any issues with this job please use the Report Job button on GrabJobs. Apply tot his job