Senior Coding Compliance Auditor - Inpatient

Ensemble Health Partners; Alton (IL); Remote; USD 90,000 - 130,000; Full time

Benefits offered by this job

Tuition Reimbursement

Bonus Incentives

Remote Work

Benefits package

Job summary

Ensemble Health Partners is seeking a Senior Coding Compliance Auditor to lead comprehensive coding audits and develop an Annual Compliance Workplan. You will mentor auditors, prepare detailed reports, and drive actions to mitigate compliance risks.

Responsibilities include auditing, MAP development, and analytics to identify trends. Travel up to 10% to client sites or offices is required, with remote coordination from the home office.

Qualifications

• 5-7+ years of experience in healthcare, acute coding, Compliance, audits, or related field.
• ICD-10, DRG, CPT & HCPCs coding knowledge including Acute Outpatient and Inpatient experience.
• Revenue cycle operations, Compliance standards, auditing standards knowledge.
• Epic, Cerner, and/or Meditech knowledge.
• Long-distance or air travel – not to exceed 10% travel.

Responsibilities

• Assist with development and execution of the Annual Compliance Workplan and Auditing and Monitoring Workplans.
• Lead and complete detailed coding compliance audits including complex audits.
• Prepare high quality audit reports and MAPs (Management Action Plans).
• Coach and mentor new and existing Coding auditors.
• Communicate coding compliance concerns to Compliance leadership with trends and patterns.
• Maintain compliance documents, analytical reports, and audit records.
• Assist with onboarding of new Compliance coding auditors and provide ongoing support.

Skills

Healthcare compliance auditing

Auditing standards

Coding knowledge ICD-10

Travel willingness

Education

Bachelor's degree or equivalent in Health Records Management/Medical Coding

Tools

Epic

Cerner

Meditech

Job description

Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. 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. Customer Obsession: Bonus Incentives

Tuition Reimbursement

By embodying our core purpose of customer obsession, new ideas, and driving innovation, and delivering excellence, you will help ensure that every touchpoint is meaningful and contributes to our mission of redefining the possible in healthcare.

The Senior Coding Compliance Auditor will assist with the development and execution of the Annual Compliance Workplan including the Auditing and Monitoring Workplans. They will lead & complete detailed Coding compliance audits including complex audits, implement Management Action Plans, prepare high quality audit reports, establish and maintains an Audit the Auditor Quality program, coaches and mentors new and existing Coding auditors, and participate in other compliance program related activities. The senior auditor is expected to work independently with minimal supervision, will manage projects/initiatives as assigned, use analytical and problem-solving skills to assist the auditors with their complex account reviews.

Accountability - Accepts personal responsibility and/or consequences of failure and successes, delivering on commitments and refocusing effort when needed. Time Management - Effectively manages personal time and resources to ensure that work is completed efficiently.

Conduct detailed coding auditing and monitoring activities on acute side.

Analyze audit findings to identify discrepancies, trends, patterns which may lead to potential non-compliance and develop well thought actionable recommendations to mitigate associated risks, and partner with the service line leaders to develop and validate Management Action Plans.

Create and maintain an Audit the Auditor program to monitor quality and identify opportunities for improvement related to audit management tools as well as audit processes.

Provide regular updates to the Compliance leader on audits, MAPs outcomes, and elevate potential compliance concerns which require immediate attention.

Create and maintain training material for Audit process and how to use the Audit Management tool/platform. And leverage it to provide training, education, and ongoing support to the auditors.

Effectively and timely communicate coding compliance concerns to Compliance leadership through identifying trends and patterns.

Serve as a resource for Coding leaders on compliance audits related questions and concerns. Create and maintain Compliance audit records, analytical reports, and track and trend compliance audit program activities; manage compliance audit program issue logs and dashboards.

Maintains accurate, complete, and up-to-date compliance documents and records and produce for Compliance leadership upon request.

Assist with onboarding of the new Compliance coding auditors and serve as a resource for the auditors to address their questions/concerns.

Foster a culture of compliance and continuous improvement within the department and the organization.

Assist with assessing the Compliance audit program on ongoing basis to identify opportunities for process improvement. Contribute to the achievement of Compliance Department goals and objectives and adhere to departmental policies, procedures, and standards; comply with organizational policies and procedures, governmental laws and regulations and accreditation standards.

Assist with work assignment of the auditors and follow up on deliverables to ensure deadlines are met.

Assist with the development and preparation of the annual risk assessment and work plan.

Help evaluate the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to corporate integrity and compliance.

Participate in other projects as assigned and complete tasks within requested timeframes. Participate in periodic compliance program effectiveness evaluations.

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job.

• 5-7+ years of experience in healthcare, acute coding, Compliance, audits, or related field
• ~ ICD-10, DRG, CPT & HCPCs coding knowledge to include Acute Outpatient and Inpatient experience
• ~ Revenue cycle operations, Compliance standards, auditing standards knowledge
• ~ Epic, Cerner, and/or Meditech knowledge
• ~ Basic Word & Excel knowledge
• ~ Long-distance or air travel - not to exceed 10% travel
• ~ 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

CHC (Certified in Healthcare Compliance) May be obtained at designated time upon acceptance into role

CCS (Certified Coding Specialist)

Bachelors degree or equivalent experience, Health Records Management/Medical Coding, preferred

LI-REMOTE

• 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
• Monster Top Workplace for Remote Work 2024
• 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.
• Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
• 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. 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. 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 equity;