Senior Coding Compliance Auditor - Outpatient

Ensemble Health Partners; Springfield (IL); On-site; USD 76,000 - 132,000; Full time

Benefits offered by this job

Bonus incentives

Paid certifications

Tuition reimbursement

Comprehensive benefits

Career advancement

Job summary

Ensemble Health Partners seeks a Senior Coding Compliance Auditor to develop and execute the Annual Compliance Workplan, leading complex coding audits and mentoring auditors.

The role requires 5-7+ years in healthcare coding, compliance, and auditing, with knowledge of ICD-10 and CPT/HCPCS; familiarity with Epic, Cerner, or Meditech is a plus. This position offers strong growth within a leading health tech company.

Qualifications

• 5-7+ years of experience in healthcare, acute coding, compliance, audits, or related field.
• ICD-10, DRG, CPT & HCPCS coding knowledge for Acute outcomes
• Experience with revenue cycle operations and auditing standards.

Responsibilities

• Conduct detailed coding auditing and monitoring activities on acute side.
• Analyze audit findings and develop actionable recommendations to mitigate risks.
• Create and maintain an Audit the Auditor program and training materials.
• Provide regular updates to Compliance leadership on audits and MAP outcomes.
• Assist with onboarding new auditors and foster a culture of compliance.

Skills

Healthcare compliance

Auditing

Coding knowledge

Education

Health Records Management / Medical Coding

Tools

Epic

Cerner

Meditech

Job description

About Ensemble

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 pays between $76,300 - $131,550 based on experience.

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.

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.

Job Competencies

• Valuing Differences - Works effectively with individuals of diverse cultures, interpersonal styles, abilities, motivations, or backgrounds; seeks out and uses unique abilities, insights, and ideas. Considers the collective.
• Collaboration - Works cooperatively within teams and partners with others, both internally and externally as needed, to achieve success; focuses on the results of the team, not the achievements of one person. It’s "All for One and One for All"
• Accountability - Accepts personal responsibility and/or consequences of failure and successes, delivering on commitments and refocusing effort when needed. Someone who is willing to step up and own it.
• Time Management - Effectively manages personal time and resources to ensure that work is completed efficiently.
• Developing Trust - Gains others’ confidence by acting with integrity and following through on commitments; treats others and their ideas with respect and supports them in the face of challenges.
• Takes Initiative - Takes prompt action to accomplish goals and achieve results beyond what is required; is proactive and pursues relentlessly.

Essential Job Functions

• 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 escalating 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.
• Keep up with coding guidelines and industry standards for coding practices.
• 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.
• Effectively maintain open, effective, and collaborative working relationships with internal and external stakeholders.
• 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.

Experience We Love

• 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
• 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

Required Certifications

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

Education Level

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

LI-LS1LI-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 2023-2024InnovationWork-Life FlexibilityLeadershipPurpose + Values

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.

This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range.

Employment Disclaimers – Ensemble