Outpatient Coding Auditor

Ensemble Health Partners; Northern (KY); Hybrid; 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 an experienced Outpatient Facility Coding Auditor to audit outpatient coding accuracy and apply ICD-10-CM, CPT, and CMS guidelines. You will work under indirect supervision to ensure diagnoses and codes support clinical documentation and comply with regulations.

The role requires 3+ years in outpatient coding and auditing, strong communication skills, and proficiency with Microsoft Office.

Qualifications

• 3+ years of outpatient facility coding experience.
• 3+ years of auditing experience.
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing.
• Knowledge of current and developing issues and trends in medical coding procedures requirements.
• Ability to clearly communicate medical information to professional practitioners and/or the general public.
• Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements.
• Ability to provide guidance and training to staff in area of expertise.
• Competent with the use of all Microsoft Office applications, including Word, Excel, and Power Point.
• 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.

Responsibilities

• The audit professional integrates medical coding principles and objectivity in the performance of coding audit activities.
• Draws on ICD10CM, HCPCS, NCCI, and CMS coding expertise to substantiate coding principles and identify issues.
• Participates in client system education to audit accounts and ensure coding is supported by documentation and guidelines.
• Maintain meticulous documentation and examples of root cause issues across accounts and claims.
• Search governmental and payor literature to identify coding and billing requirements and provide recommendations.
• Assist in developing executive summaries and training materials for client coding teams.
• Meet productivity standards for coding audits and certification requirements.
• Attend coding conferences/workshops to stay updated on changes.

Skills

Outpatient coding

Auditing

Medical coding knowledge

Regulatory compliance

Communication skills

Microsoft Office

AI openness

Education

High School Diploma or GED

CPC (Certified Professional Coder)

CCS (Certified Coding Specialist)

RHIA (Registered Health Information Administrator)

RHIT (Registered Health Information Technician)

Tools

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 will pay between $57,400 to $99,000 based on experienceThe **Outpatient Facility Coding Auditor** integrates medical coding principles and objectivity in the performance of outpatient coding audit activities. Draws on ICD10CM, CPT and CMS coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues, and quality concerns. Under indirect supervision, the Coding Auditor will audit the quality of all outpatient work types to assure appropriateness and accuracy of Diagnoses, CPT, HCPCS, CCI edits, modifier assignment in accordance with ICD10 CM, CPT, HCPCS, CPT Assistant, Coding Clinic, Center of Medicare and Medicaid (CMS) guidelines, and National Correct Coding Initiatives (NCCI).**Job Responsibilities:*** The audit professional integrates medical coding principles and objectivity in the performance of coding audit activities. Draws on ICD10CM, HCPCS, NCCI, and CMS coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues, and quality concerns* Participates in client system education to gain the knowledge necessary to audit client accounts in ensuring that the coding is supported by the patient's clinical documentation, coding/cdi guidelines and other regulatory standards/guidelines as appropriate* Maintain meticulous documentation, spreadsheets, account, and claim examples of root cause issues. Performs searches of governmental, payor-specific, hospital-specific, regulatory body, and literature rules, regulations, guidelines to identify and coding and billing requirements to make recommendations to client* Assist in the development and coordination of the executive summary reports, education and training client coding companion as it relates to the outcomes of the coding audit* Meet established productivity standards for coding audits & coding certification requirement* Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations* Provides excellent customer service, in an organized and efficient manner, while maintaining a positive attitude**Experience We Love:*** 3+ years of outpatient facility coding experience* 3+ years of auditing experience* Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements* Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation* Knowledge of current and developing issues and trends in medical coding procedures requirements* Ability to clearly communicate medical information to professional practitioners and/or the general public* Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements* Ability to provide guidance and training to professional and technical staff in area of expertise* Competent with the use of all Microsoft Office applications, including Word, Excel, and Power Point.* 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:*** High School Diploma or GED**Required Certifications:**Candidate 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)LI-HB1LI-Remote**Join an award-winning company**Five-time winner of \"Best in KLAS\" 2020-2022, 2024-2025Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-202422 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023Energage Top Workplaces USA 2022-2024Fortune Media Best Workplaces in Healthcare 2024Monster Top Workplace for Remote Work 2024Great Place to Work certified 2023-2024* Innovation* Work-Life Flexibility* Leadership* Purpose + ValuesBottom 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] posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors,