DRG Validation Coding Auditor

Ensemble Health Partners; United States; Remote; USD 51,000 - 99,000; Full time

Job summary

Join a forward-thinking company dedicated to empowering healthcare providers through innovative revenue cycle management solutions. This role offers a unique opportunity to lead training and quality assurance efforts for medical coding professionals. You will develop educational resources, conduct audits, and ensure compliance with coding standards while fostering a culture of growth and collaboration. With a focus on professional development, including paid certifications and tuition reimbursement, this position is perfect for those looking to advance their careers in a supportive environment. Be a part of a team that values meaningful contributions and strives for excellence in healthcare services.

Benefits

Bonus Incentives

Paid Certifications

Tuition Reimbursement

Comprehensive Benefits

Career Advancement

Qualifications

• 5+ years of coding experience with proficiency in multiple EMRs.
• 3+ years of facility coding audit experience is preferred.

Responsibilities

• Monitor and audit inpatient/outpatient accounts for coding accuracy.
• Develop and implement training programs for coding staff.

Skills

Coding Experience

Facility Coding Audit

HIPAA Regulations Knowledge

Communication Skills

Time Management

Medical Terminology Understanding

Education

High School Diploma or GED

Tools

EMR Systems

Microsoft Office Suite

Job description

Thank you for considering a career at Ensemble Health Partners!

Ensemble Health Partners 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.

The Opportunity:

• Bonus Incentives

• Paid Certifications

• Tuition Reimbursement

• Comprehensive Benefits

• Career Advancement

• This position pays between $51,700 – $99,000 based on experience.

Develops and implements strategic needs analyses and training plans for coding leadership; coordinates and evaluates curriculum development and conducts the preparation and delivery of training for Facility Medical Coders employed by Ensemble and providers that are contracted/employed and outlined in the client SOW. Provides guidance and leadership to coding and billing management in the implementation and administration of effective systems, processes, and procedures. Performs annual performance reviews and quality assurance reviews to assess comprehension of training efforts. Serves as a technical resource for all involved personnel; ensures that information is accurate and current, meeting facility coding standards.

Job Responsibilities:

• Quality Review - Monitors and audits inpatient and/or outpatient accounts across the system, looking at facility coding for inpatient and/or outpatient accounts. Performs annual performance, randomized and quality assurance reviews to assess comprehension of training efforts. Performs DRG Validation reviews, ensuring proper facility coding guidelines have been followed as well as reviewing for clinical support of the coded diagnoses. Also assists other external and regulatory audits.

• Educating - Assesses the educational needs of coding staff that are contracted/employed and outlined in the client SOW and develops programs or researches educational resources to meet those needs. Assists with Task Force, CDE and quality department related education. Creates presentations, develops learning material, handbook and other educational materials.

• Edits/Denials/Coding - Assists with edits, denials and appeals. Also assists with coding and working holds 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 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 (Included Provider verbiage). 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 facility coding audit experience (such as DRG and APC Validation).

• 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.

Minimum Education:

• High School Diploma or GED.

Required Certifications:

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

• CPC (Certified Professional Coder)

• CCS (Certified Coding Specialist)

• RHIA (Registered Health Information Administrator)

• RHIT (Registered Health Information Technician)

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.

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 Health Partners 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 Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble Health Partners 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].