Outpatient Coding Auditor

Ensemble RCM LLC; EE. UU.; A distancia; USD 57.000 - 99.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Comprehensive benefits package

Tuition reimbursement

Professional certifications support

Incentive programs

Descripción de la vacante

Ensemble Health Partners is seeking an Outpatient Facility Coding Auditor to join our team in the United States. You will apply ICD10-CM, CPT, and CMS guidelines to audit outpatient coding accuracy, ensuring compliant and precise diagnoses, procedures, and modifier use across client accounts.

With 3+ years in outpatient coding and auditing, you will contribute to high-quality billing that supports patient care and reimbursement.

Formación

• 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 regulatory and policy compliance issues related to medical coding and billing procedures.

Responsabilidades

• Audit outpatient coding accuracy across diagnoses, CPT, HCPCS, and modifiers.
• Use ICD-10-CM, CPT, HCPCS, CPT Assistant, Coding Clinic, CMS, and NCCI guidelines to identify issues.
• Educate client systems to ensure coding aligns with clinical documentation and regulatory standards.
• Maintain meticulous documentation and provide root-cause analyses.
• Research payor rules and literature to identify coding requirements and provide recommendations.
• Support development and coordination of executive summaries and training materials.

Conocimientos

Outpatient coding

Auditing

ICD10-CM

CPT/CMS knowledge

Educación

High School Diploma or GED

Herramientas

Microsoft Office

Descripción del empleo

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 experience

The 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.

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-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].

If you are a passionate, dedicated and experienced revenue cycle, consulting or finance professional and seek career and personal growth, we would love to hear from you. We believe we foster an environment where talented individuals can excel and shine. Our team believes that people are the most important part of our success and that when we take care of our people, they pay it forward by providing our clients with excellent results and world-class service.