Outpatient Coding Auditor

Position Description CGI 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 Conduct detailed medical record reviews to identify coding discrepancies, reimbursement inaccuracies, and potential payment recovery opportunities across outpatient facility, professional, and allied health claims Evaluate clinical documentation, coding accuracy, and reimbursement methodologies to determine compliance with applicable coding standards, payer policies, and regulatory requirements Develop clear, comprehensive audit findings and written rationales supported by authoritative coding references, clinical documentation, and reimbursement guidelines Apply 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 determinations Interpret and apply CPT Assistant, Coding Clinic for HCPCS, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and client-specific reimbursement and medical policies Collaborate with the Edit Development team to provide feedback on claims selection criteria, emerging coding trends, and new payment recovery concepts Maintain established audit quality, productivity, accuracy, and documentation standards while meeting client requirements and contractual deliverables Communicate audit findings, coding interpretations, and recommendations effectively with team leads, internal stakeholders, and healthcare providers when applicable Adapt to evolving audit priorities, regulatory changes, and client requirements while maintaining compliance with CGI policies, procedures, and operational expectations Participate in ongoing training, professional development, and occasional onsite provider reviews or other business-related travel as required Required Qualifications To Be Successful In This Role 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 setting Extensive knowledge of ICD-10-CM, CPT, and HCPCS coding guidelines, including appropriate modifier usage, coding conventions, and documentation requirements Working knowledge of the Centers for Medicare & Medicaid Services (CMS) Outpatient Prospective Payment System (OPPS), Ambulatory Payment Classifications (APCs), NCCI edits, and OCE edits Demonstrated ability to analyze complex medical records, interpret clinical documentation, and identify coding or reimbursement discrepancies Strong critical thinking, analytical, and problem-solving skills with the ability to make independent, evidence-based audit determinations Excellent written communication skills, including the ability to develop clear, accurate, and well-reasoned audit narratives with appropriate supporting references Experience using coding encoders, electronic medical records, and remote medical record review systems Proficiency with Microsoft Office applications, including Outlook, Word, and Excel, and familiarity with Windows-based operating systems Strong organizational and time-management skills, with the ability to work independently, adapt to changing priorities, and consistently meet established quality and productivity standards Desired Qualifications / Strongly Preferred Outpatient surgical coding experience in specialty areas such as orthopedics, cardiology, spine and back procedures, and interventional radiology Previous experience conducting coding audits, peer reviews, payment integrity reviews, or healthcare reimbursement compliance assessments Experience training, mentoring, or providing quality feedback to junior-level coders or coding professionals Familiarity with Charge Description Master (CDM) structures, maintenance, and reimbursement implications Experience using TruCode encoder software and other advanced coding or audit applications Experience supporting healthcare payer audits, recovery initiatives, or complex outpatient claims reviews Other Information: CGI is required by law in some jurisdictions to include a reasonable estimate of the compensation range for this role. The determination of this range includes various factors not limited to skill set, level, experience, relevant training, and licensure and certifications. To support the ability to reward for merit based performance, CGI typically does not hire individuals at or near the top of the range for their role. Compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range for this role in the U.S. is $70,800.00 $123,800.00. CGI's benefits are offered to eligible professionals on their first day of employment to include: Competitive compensation Comprehensive insurance options Matching contributions through the 401(k) plan and the share purchase plan Paid time off for vacation, holidays, and sick time Paid parental leaveLearning opportunities and tuition assistance Wellness and Well being programs CGI Federal anticipates accepting applications for this position through 2026 12 31. 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. Come join our team—one of the largest IT and business consulting services firms in the world. Qualified applicants will receive consideration for employment without regard to their race, ethnicity, ancestry, color, sex, religion, creed, age, national origin, citizenship status, disability, pregnancy, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity, and gender expression, familial status or responsibilities, reproductive health decisions, political affiliation, genetic information, height, weight, or any other legally protected status or characteristics to the extent required by applicable federal, state, and/or local laws where we do business. CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at US_Employment_Compliance@cgi.com. You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned. We make it easy to translate military experience and skills! Click here to be directed to our site that is dedicated to veterans and transitioning service members. All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held. Dependent upon role and/or federal government security clearance requirements, and in accordance with applicable laws, some background investigations may include a credit check. CGI will consider for employment qualified applicants with arrests and conviction records in accordance with all local regulations and ordinances. CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI’s legal duty to furnish information.