Coder Quality Auditor

Ensemble Health Partners; United States; Remote; USD 57,000 - 99,000; Full time

Benefits offered by this job

Bonus Incentives

Paid Certifications

Tuition Reimbursement

Comprehensive Benefits

Career Advancement

Job summary

Ensemble Health Partners is seeking a Coder Quality Auditor to join our remote team in the United States. The role involves quality assessments of coding across inpatient and outpatient accounts, education of staff, and handling edits, denials, and appeals in coordination with CMS/AMA guidelines.

We require 5+ years of coding and 3+ years of auditing experience, HIPAA knowledge, and strong English communication.

Qualifications

• 5+ years coding experience.
• 3+ years auditing experience.
• Proficiency in multiple EMRs, encoders, and the Microsoft Office suite.
• Educated in HIPAA regulations; must maintain confidentiality.
• Ability to read, write and communicate in English.
• Ability to understand medical/surgical terminology.

Responsibilities

• Quality Review - Monitors and audits inpatient and outpatient coding across the system, performing baselines and QA reviews.
• Educating - Assesses educational needs and creates training materials and handbooks.
• Edits/Denials/Coding - Assists with initial coding, edits, denials, and appeals.
• Training - Develops materials for formal and on‑the‑job training and identifies cross-training needs.
• Resource - Serves as a technical resource ensuring accuracy and AMA/CMS standards.
• Reporting - Provides audit findings to management and providers; flags compliance risks.

Skills

Coding experience

Auditing experience

EMR proficiency

MS Office

HIPAA knowledge

English proficiency

Medical terminology

Education

Associates degree or equivalent experience

Tools

EMR systems

Encoders

Microsoft Office

Job description

Thank you for considering a career at Ensemble!

Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.

Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!

O.N.E Purpose:

• Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.

• Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.

• Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

The Opportunity:

CAREER OPPORTUNITY OFFERING:

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement
• This position pays between $57,400 to $99,000 annually based on experience

The Coder Quality Auditor 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. Candidate should possess the ability to code and a clear understanding of the coding principles and guidelines for multiple specialties.

Job Responsibilities:

• Quality Review - 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. Also assists in special project audits, as assigned.
• Educating - Assesses the educational needs of coding staff based on individual coder audit results and overall trends. Creates presentations, develops learning material, handbook and other educational materials.
• Edits/Denials/Coding - Assists operational coding team with initial coding, edits, and denials and appeals on an as needed basis.
• Training - 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. Identifies coders to be cross-trained and suggests areas for training improvement. Assists in the implementation and administration of effective systems, processes, and procedures.
• Resource - Serves as a technical resource for all involved personnel; ensures that information is accurate and current, meeting AMA, CMS, and professional coding standards. Performs miscellaneous job-related duties as assigned.
• Reporting - 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. Assists with the creation of various documents and reports as requested. Immediately provides reports related to compliance risks when requested.

Experience We Love:

• 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.

• This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Minimum Education:

• Associates degree or equivalent experience

Required Certifications:

Candidates must have and keep current at least one of the following professional certifications (CPC, CPMA or CCS Preferred):

• CPC (Certified Professional Coder)
• CCS-P (Certified Coding Specialist-Phys Based)
• CCS (Certified Coding Specialist)
• CMPA (Certified Professional Medical Auditor)
• RHIA (Registered Health Information Administrator)
• RHIT (Registered Health Information Technician)

#LI-HB1

#LI-REMOTE

Join an award-winning company

Five-time winner of “Best in KLAS” 2020-2022, 2024-2025

Black Book Research’s Top Revenue Cycle Management Outsourcing Solution 2021-2024

22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024

Leader in Everest Group’s RCM Operations PEAK Matrix Assessment 2024

Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023

Energage Top Workplaces USA 2022-2024

Fortune Media Best Workplaces in Healthcare 2024

Monster Top Workplace for Remote Work 2024

Great Place to Work certified 2023-2024

• Innovation
• Work-Life Flexibility
• Leadership
• Purpose + Values

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:

• Associate Benefits – We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
• Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
• Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Ensemble is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble also prohibits harassment of applicants or employees based on any of these protected categories.

Due to business, operational, payroll, and regulatory requirements, this position is limited to individuals who reside and are authorized to work within the United States. Applications generated from outside the United States will not be considered. Individuals may reapply when located within the United States.

Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact [e-mail].

This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range.

Employment Disclaimers – Ensemble