Outpatient Coding Auditor

Outpatient Coding AuditorCGI is one of the largest global IT and business consulting services firms, helping clients achieve meaningful outcomes through technology, expertise, and innovation. With a global presence and a collaborative, ownership-driven culture, CGI empowers its professionals to deliver impactful solutions that make a difference for clients and the communities they serve.CGI is seeking an experienced Outpatient Coding Auditor to join our Healthcare Compliance Audit Team. In this role, you will leverage your outpatient coding, clinical documentation, and reimbursement expertise to conduct comprehensive medical record audits and identify potential improper payments, including overpayments and underpayments. You will review claims across outpatient hospitals, ambulatory surgical centers, physician practices, and other healthcare settings, delivering accurate, well-supported, and thoroughly documented audit findings.This is a fully remote position open to candidates located anywhere in the United States. Candidates must be available to work Eastern Time Zone business hours. The ideal candidate is a self-motivated, detail-oriented professional with strong analytical, critical thinking, and written communication skills who thrives in an independent, collaborative environment. CGI provides ongoing training and professional development to support evolving audit methodologies, regulatory requirements, and industry standards.Your future duties and responsibilities include:Conduct detailed medical record reviews to identify coding discrepancies, reimbursement inaccuracies, and potential payment recovery opportunities across outpatient facility, professional, and allied health claimsEvaluate clinical documentation, coding accuracy, and reimbursement methodologies to determine compliance with applicable coding standards, payer policies, and regulatory requirementsDevelop clear, comprehensive audit findings and written rationales supported by authoritative coding references, clinical documentation, and reimbursement guidelinesApply ICD-10-CM, CPT, HCPCS, National Correct Coding Initiative (NCCI) edits, Outpatient Code Editor (OCE) edits, and other applicable coding and payment methodologies to support accurate audit determinationsInterpret and apply CPT Assistant, Coding Clinic for HCPCS, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and client-specific reimbursement and medical policiesCollaborate with the Edit Development team to provide feedback on claims selection criteria, emerging coding trends, and new payment recovery conceptsMaintain established audit quality, productivity, accuracy, and documentation standards while meeting client requirements and contractual deliverablesCommunicate audit findings, coding interpretations, and recommendations effectively with team leads, internal stakeholders, and healthcare providers when applicableAdapt to evolving audit priorities, regulatory changes, and client requirements while maintaining compliance with CGI policies, procedures, and operational expectationsParticipate in ongoing training, professional development, and occasional onsite provider reviews or other business-related travel as requiredRequired qualifications to be successful in this role include:Current professional coding certification through AHIMA or AAPC, such as RHIT, RHIA, CCS-P, CPC, or COC (formerly CPC-H)Minimum of five years of outpatient surgical coding experience in a facility and/or professional healthcare settingExtensive knowledge of ICD-10-CM, CPT, and HCPCS coding guidelines, including appropriate modifier usage, coding conventions, and documentation requirementsWorking knowledge of the Centers for Medicare & Medicaid Services (CMS) Outpatient Prospective Payment System (OPPS), Ambulatory Payment Classifications (APCs), NCCI edits, and OCE editsDemonstrated ability to analyze complex medical records, interpret clinical documentation, and identify coding or reimbursement discrepanciesStrong critical thinking, analytical, and problem-solving skills with the ability to make independent, evidence-based audit determinationsExcellent written communication skills, including the ability to develop clear, accurate, and well-reasoned audit narratives with appropriate supporting referencesExperience using coding encoders, electronic medical records, and remote medical record review systemsProficiency with Microsoft Office applications, including Outlook, Word, and Excel, and familiarity with Windows-based operating systemsStrong organizational and time-management skills, with the ability to work independently, adapt to changing priorities, and consistently meet established quality and productivity standardsDesired qualifications / Strongly preferred:Outpatient surgical coding experience in specialty areas such as orthopedics, cardiology, spine and back procedures, and interventional radiologyPrevious experience conducting coding audits, peer reviews, payment integrity reviews, or healthcare reimbursement compliance assessmentsExperience training, mentoring, or providing quality feedback to junior-level coders or coding professionalsFamiliarity with Charge Description Master (CDM) structures, maintenance, and reimbursement implicationsExperience using TruCode encoder software and other advanced coding or audit applicationsExperience supporting healthcare payer audits, recovery initiatives, or complex outpatient claims reviewsWhat you can expect from us:Together, as owners, let's turn meaningful insights into action. Life at CGI is rooted in ownership, teamwork, respect and belonging. Here, you'll reach your full potential because… You are invited to be an owner from day 1 as we work together to bring our Dream to life. That's why we call ourselves CGI Partners rather than employees. We benefit from our collective success and actively shape our company's strategy and direction.Your work creates value. You'll develop innovative solutions and build relationships with teammates and clients while accessing global capabilities to scale your ideas, embrace new opportunities, and benefit from expansive industry and technology expertise.You'll shape your career by joining a company built to grow and last. You'll be supported by leaders who care about your health and well-being and provide you with opportunities to deepen your skills and broaden your horizons.