Outpatient Coding Auditor

ensemblehp; 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 is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. The Outpatient Facility Coding Auditor role integrates medical coding principles and CMS guidelines to ensure accuracy and compliance across client sites.

You will work remotely with on-site travel to client locations, bringing 3+ years of outpatient coding and auditing experience, CPC/CCS/RHIA certifications, and a focus on quality,

Qualifications

• 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 compliance issues related to medical coding and billing procedures.
• Ability to clearly communicate medical information to professionals and the public.

Responsibilities

• The audit professional integrates medical coding principles to determine potential billing/coding issues and quality concerns.
• Participates in client system education to audit accounts ensuring coding is supported by documentation and guidelines.
• Maintains meticulous documentation, spreadsheets, and examples of root cause issues; researches rules and regulations to inform recommendations.
• Assists in developing executive summary reports and client training materials related to audit outcomes.
• Meets productivity standards for coding audits and certification requirements.
• Attends coding conferences and training to stay updated on changes in coding and regulations.
• Provides excellent customer service in an organized and efficient manner.

Skills

Outpatient coding

Auditing

Regulatory knowledge

Communication

Analytical thinking

Education

High School Diploma or GED

CPC (Certified Professional Coder)

CCS (Certified Coding Specialist)

RHIA (Registered Health Information Administrator)

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:

• 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.

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:

• CPC (Certified Professional Coder)
• CCS (Certified Coding Specialist)
• RHIA (Registered Health Information Adminis)