Senior Outpatient Coding Auditor & Provider Education Specialist

The Senior Outpatient Coding Auditor & Provider Education Specialist serves as a key liaison between EXL's healthcare payer clients and those providers selected into the EXL education program by delivering clear, accurate, and constructive guidance on coding practices. This role is also responsible for conducting comprehensive audits of outpatient services to ensure compliance with coding, billing, and reimbursement guidelines. The ideal candidate combines deep technical expertise with strong interpersonal skills to effectively educate providers, address concerns, and foster collaborative relationships.

Salary Range: $90,000 - $100,000 (based on experience, skills, and qualifications)

Location: 100% Remote (U.S.-based)

️ Up to 10% annual travel (for team meetings and limited client onsite engagements.)

A brief coding/auditing assessment may be included as part of the interview process

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com.

EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL's Human Resources team, as well as our hiring managers.

• Bachelor's degree in Health Information Management, Healthcare Administration, or related field (or equivalent experience).
• Minimum of 5+ years of outpatient coding, auditing, or compliance experience.
• Active certification such as AAPC (e.g., CPC, CPMA) or AHIMA (e.g., CCS, CCS-P, RHIT, RHIA).
• Extensive knowledge of CPT, HCPCS, and ICD-10 coding systems, as well as CMS and payer reimbursement methodologies.
• Demonstrated experience auditing E/M services and other outpatient procedures.

Preferred Qualifications

• Experience in provider education or clinical documentation improvement (CDI).
• Experience working directly with physicians, advanced practice providers, and behavioral health clinicians.
• Background in healthcare analytics or performance improvement initiatives.

Core Competencies

• Communication Excellence: Ability to explain complex coding and reimbursement concepts clearly and effectively.
• Emotional Intelligence: Skilled at navigating sensitive conversations with professionalism and empathy.
• De-escalation & Conflict Management: Proven ability to manage and resolve challenging provider interactions.
• Analytical Thinking: Strong ability to understand and communicate provider billing trend metrics.
• Credibility & Influence: Builds trust with providers through expertise and respectful engagement.
• Adaptability: Able to tailor messaging based on provider specialty, experience, and receptiveness.

Why This Role Matters

This position plays a critical role in improving coding accuracy, supporting compliant reimbursement, and strengthening provider relationships through education. By combining technical expertise with effective communication, this role directly contributes to both payment integrity and provider success.

What We Offer:

A fast-paced, innovative environment with a team of industry-leading experts.

Hands-on experience with top-tier clients in the healthcare industry.

Mentorship and career development programs to help you grow professionally.

A strong culture of collaboration, support, and inclusivity.

Competitive benefits package, including healthcare, vision, dental, and 401(k) options.

Ready to Take Your Career to the Next Level?

If you''re looking for a rewarding and challenging opportunity where your expertise will be valued, your growth will be supported, and your contributions will make a difference-apply today and become part of the EXL team!

Provider Education & Engagement

• Conduct one-on-one and group education sessions with providers to explain observed billing trends, coding requirements and best practices.
• Reinforce appropriate documentation standards to support accurate code selection and reimbursement.
• Translate complex coding and reimbursement guidelines into clear, practical guidance tailored to provider workflows.

Provider Communication & Relationship Management

• Serve as a primary point of contact for providers participating in the education program.
• Respond to provider inquiries regarding coding guidelines, documentation requirements, and reimbursement policies in a timely and professional manner.
• Build trust and credibility with providers through respectful, transparent, and solution-oriented communication.
• Maintain a congenial and collaborative tone in all interactions.

Conflict Resolution & De-escalation

• Effectively manage challenging conversations with providers, including those who may be frustrated or resistant to feedback.
• Utilize de-escalation techniques to address concerns, reduce tension, and guide discussions toward constructive outcomes.
• Balance enforcement of compliance standards with a supportive, educational approach.

Audit & Compliance

• Perform detailed audits of outpatient medical records to assess accuracy of CPT, HCPCS, and ICD-10 coding, as well as compliance with payer policies and regulatory requirements.
• Identify patterns of coding variation, documentation deficiencies, and potential compliance risks.
• Develop audit findings, summaries, and provider-specific feedback reports with actionable recommendations.
• Ensure alignment with current coding guidelines, including AMA CPT, CMS, NCCI, and payer-specific policies.

Provider Education & Engagement

• Conduct one-on-one and group education sessions with providers to explain observed billing trends, coding requirements and best practices.
• Reinforce appropriate documentation standards to support accurate code selection and reimbursement.
• Translate complex coding and reimbursement guidelines into clear, practical guidance tailored to provider workflows.

Provider Communication & Relationship Management

• Serve as a primary point of contact for providers participating in the education program.
• Respond to provider inquiries regarding coding guidelines, documentation requirements, and reimbursement policies in a timely and professional manner.
• Build trust and credibility with providers through respectful, transparent, and solution-oriented communication.
• Maintain a congenial and collaborative tone in all interactions.

Conflict Resolution & De-escalation

• Effectively manage challenging conversations with providers, including those who may be frustrated or resistant to feedback.
• Utilize de-escalation techniques to address concerns, reduce tension, and guide discussions toward constructive outcomes.
• Balance enforcement of compliance standards with a supportive, educational approach.

Audit & Compliance

• Perform detailed audits of outpatient medical records to assess accuracy of CPT, HCPCS, and ICD-10 coding, as well as compliance with payer policies and regulatory requirements.
• Identify patterns of coding variation, documentation deficiencies, and potential compliance risks.
• Develop audit findings, summaries, and provider-specific feedback reports with actionable recommendations.
• Ensure alignment with current coding guidelines, including AMA CPT, CMS, NCCI, and payer-specific policies.