Quality Auditor, Coder

🕒 March 18

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Ensemble Health Partners

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

⚕️ Healthcare Insurance

☁️ SaaS

🏢 Enterprise

💰 Private Equity Round on 2022-03

Healthcare Insurance • SaaS • Enterprise

Ensemble Health Partners is a leading provider of revenue cycle management (RCM) services for healthcare organizations. They offer an end-to-end RCM solution that helps hospitals, health systems, and affiliated physician groups optimize their revenue cycles, reduce denials and underpayments, and enhance patient experiences using a combination of expert management and advanced technology. Ensemble Health Partners leverages certified operators and AI to deliver consistent results, improve collections, and support future growth for healthcare providers. They are recognized for their robust client partnerships and commitment to delivering reliable revenue lift and cost savings for their clients.

📋 Description

• Conducts monthly and quarterly quality assessments of individual codes. • Provides guidance and education to coding associates and leaders on established coding guidelines and procedures. • Performs additional quality assurance follow-up reviews to assess comprehension of education and training efforts. • Serves as a subject matter expert for professional fee coding for all involved personnel; ensures that information is accurate and current, meeting professional coding standards and following CMS/AMA guidelines. • Monitors and audits inpatient and outpatient accounts across the system, looking at physician coding for both inpatient and outpatient accounts. • Performs initial baselines as well as quarterly performance quality assurance reviews to assess coders’ comprehension and further assess ongoing education. • Educates the coding staff based on individual coder audit results and overall trends. • Creates presentations and develops learning material, handbook and other educational materials. • Assists operational coding team with initial coding, edits, and denials and appeals on an as needed basis. • Assists with training new and existing staff; develops all training materials and coding aids for both formal training and use by coders in daily work. • Serves as a technical resource for all involved personnel; ensures that information is accurate and current, meeting AMA, CMS, and professional coding standards. • Provides reports of audit findings to coding management, individual coders and leadership as needed/requested along with providers that are contracted/employed and outlined in the client SOW.

🎯 Requirements

• 5+ years of coding experience. • 3+ years of auditing experience. • Proficiency in multiple EMR’s, encoders, and the Microsoft Office suite. • Educated in HIPAA regulations; must maintain strict confidentiality of patient and client information. • Consistently achieves quality and productivity standards. • Ability to organize and complete work in a timely manner. • Ability to read, write and effectively communicate in English. • Ability to understand medical/surgical terminology. • Above average written and verbal communication skills. • Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.

🏖️ Benefits

• Bonus Incentives • Paid Certifications • Tuition Reimbursement • Comprehensive Benefits • Career Advancement