• Perform detailed coding audits on outpatient facility claims to validate appropriate CPT/HCPCS, revenue codes, modifiers, and ICD-10 coding in accordance with CMS, NCCI, and payer-specific rules. • Evaluate medical record documentation to ensure services are coded, billed, and reimbursed accurately. • Identify and analyze payment integrity issues including overpayments, underpayments, and incorrect billing patterns. • Collaborate with clinical, data analytics, and payment integrity teams to develop new outpatient claim review concepts and audit strategies. • Provide education and feedback to internal teams or providers based on audit findings. • Research and apply current CMS OPPS, APC, and EAPG guidelines to ensure compliant auditing practices. • Document audit findings clearly and concisely, maintaining a high standard of accuracy and quality assurance. • Contribute to the development and testing of audit tools, rule logic, and automated review concepts to enhance outpatient claim accuracy. • Stay current with regulatory updates, coding changes, and payer policy revisions.