Senior Coding Compliance Auditor - Outpatient

About the role

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, emphasizing that every touchpoint should be meaningful. By empowering employees to challenge the status quo, they believe their people make the difference.

Responsibilities

• Assist with the development and execution of the Annual Compliance Workplan, including Auditing and Monitoring Workplans.
• Lead and complete detailed coding compliance audits, including complex audits.
• Implement Management Action Plans and prepare high-quality audit reports.
• Establish and maintain an Audit the Auditor Quality program.
• Coach and mentor new and existing coding auditors.
• Work independently with minimal supervision, manage projects/initiatives as assigned, and use analytical and problem-solving skills to assist auditors with complex account reviews.
• Conduct detailed coding auditing and monitoring activities on the acute side.
• Analyze audit findings to identify discrepancies, trends, and patterns that may lead to potential non-compliance, and develop actionable recommendations to mitigate 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, MAP outcomes, and escalate potential compliance concerns requiring immediate attention.
• Create and maintain training materials for audit processes and the use of the Audit Management tool/platform, and leverage them 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 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 the onboarding of new Compliance coding auditors and serve as a resource for auditors to address their questions and 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 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 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.

Requirements

• 5–7+ years of experience in healthcare, acute coding, Compliance, audits, or a related field.
• ICD-10, DRG, CPT, and HCPCS coding knowledge, including Acute Outpatient and Inpatient experience.
• Revenue cycle operations and Compliance standards knowledge.
• Knowledge of auditing standards.
• Epic, Cerner, and/or Meditech knowledge.
• Basic Word and Excel knowledge.
• Long-distance or air travel not to exceed 10%.
• Inquisitive and open to innovation, including AI, to explore better processes and ways to improve patient and client experiences.
• Remote position; willingness and ability to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Qualifications

• Bachelor’s degree or equivalent experience in Health Records Management/Medical Coding preferred.
• Required Certifications:
  • CHC (Certified in Healthcare Compliance) may be obtained at a designated time upon acceptance into the role.
  • 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)

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, to achieve success; focuses on team results.
• 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 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.

Pay

This position pays between $76,300 and $131,550 based on experience.