Senior Coding Compliance Auditor - Inpatient

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.

About the role

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 and complete detailed Coding compliance audits including complex audits, implement Management Action Plans, prepare high-quality audit reports, establish and maintain an Audit the Auditor Quality program, coach and mentor new and existing Coding auditors, and participate in other compliance program-related activities.

The senior auditor is expected to work independently with minimal supervision, manage projects/initiatives as assigned, and use analytical and problem-solving skills to assist auditors with their complex account reviews.

This position pays between $76,300 - $131,550 based on experience and offers bonus incentives, paid certifications, tuition reimbursement, and comprehensive benefits.

Responsibilities

• Conduct detailed coding auditing and monitoring activities on the acute side.
• Analyze audit findings to identify discrepancies, trends, and patterns which may lead to potential non-compliance and develop actionable recommendations to mitigate associated risks. Partner with 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 and processes.
• Provide regular updates to the Compliance leader on audits, MAPs outcomes, and escalate potential compliance concerns requiring immediate attention.
• Create and maintain training material for the audit process and how to use the Audit Management tool/platform. Leverage it to provide training, education, and ongoing support to auditors.
• Effectively and timely communicate coding compliance concerns to Compliance leadership by identifying trends and patterns.
• Serve as a resource for Coding leaders on compliance audit-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.
• Maintain accurate, complete, and up-to-date compliance documents and records and produce them for Compliance leadership upon request.
• Assist with onboarding new Compliance coding auditors and serve as a resource for 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 an ongoing basis to identify opportunities for process improvement. Contribute to the achievement of Compliance Department goals and objectives.
• Effectively maintain open, effective, and collaborative working relationships with internal and external stakeholders.
• Assist with work assignment of 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 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.

Qualifications

• 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, and 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.
• 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.

Certifications

• CHC (Certified in Healthcare Compliance) – may be obtained at a designated time upon acceptance into the 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

Bachelor’s degree or equivalent experience, Health Records Management/Medical Coding preferred.

Skills

• 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.
• 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.
• 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.

Benefits

• Bonus incentives
• Paid certifications
• Tuition reimbursement
• Comprehensive benefits package designed to support physical, emotional, and financial health, including healthcare, time off, retirement, and well-being programs
• Professional development opportunities, including earning a professional certification relevant to the field
• Quarterly and annual incentive programs for employees who exceed expectations

About Ensemble

Five-time winner of “Best in KLAS” (2020-2022, 2024-2025), Black Book Research's Top Revenue Cycle Management Outsourcing Solution (2021-2024), 22 HFMA MAP Awards for High Performance in Revenue Cycle (2019-2024), Leader in Everest Group's RCM Operations PEAK Matrix Assessment (2024), Clarivate 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), and Great Place to Work certified (2023-2024).

Ensemble’s culture is rooted in collaboration, growth, and innovation, with a focus on empowering people and giving them the tools and resources needed to thrive.