Outpatient Coding Auditor

📋 Description

• • As an Outpatient Facility Coding Auditor at Ensemble Health Partners, you will play a critical role in ensuring the accuracy, compliance, and quality of medical coding for outpatient services. This position is pivotal in maintaining the financial health of healthcare systems by meticulously reviewing coding practices against established industry standards and regulatory guidelines.
• • You will integrate medical coding principles and objectivity into your daily audit activities, leveraging your deep expertise in ICD-10-CM, CPT, HCPCS, CCI edits, and modifier assignment. Your primary objective will be to identify potential billing and coding issues, as well as quality concerns, ensuring that all coding aligns with the patient's clinical documentation and adheres to guidelines from the Centers for Medicare & Medicaid Services (CMS) and National Correct Coding Initiatives (NCCI).
• • A key responsibility involves participating in client system education. This requires you to gain a thorough understanding of client-specific workflows and systems to effectively audit accounts and ensure coding accuracy. You will be instrumental in identifying discrepancies and providing insights that support compliant and accurate billing practices.
• • You will maintain meticulous documentation of your audit findings, including detailed spreadsheets and account/claim examples that illustrate root cause issues. This documentation is crucial for substantiating your findings and recommendations. Furthermore, you will conduct comprehensive searches of governmental, payor-specific, hospital-specific, regulatory body, and literature rules and regulations to ensure your recommendations are well-informed and compliant.
• • Collaboration is essential in this role. You will assist in the development and coordination of executive summary reports, providing clear and concise findings from your audits. You will also contribute to client education and training initiatives, acting as a coding companion to help clients understand and implement audit outcomes, thereby improving their overall coding quality.
• • Meeting established productivity standards for coding audits and coding certification requirements is a core expectation. This ensures efficient and timely review of coding practices across various outpatient work types.
• • Continuous learning is paramount. You will be expected to attend coding conferences, workshops, and in-house training sessions to stay abreast of the latest coding information, regulatory changes, and industry best practices. This commitment to ongoing education ensures you remain an expert in a constantly evolving field.
• • Providing excellent customer service is a fundamental aspect of this role. You will interact with internal teams and potentially clients, maintaining a positive attitude, organization, and efficiency in all your communications and actions.
• • Your work directly impacts Ensemble Health Partners' mission to keep communities healthy by keeping hospitals healthy. By ensuring accurate revenue cycle management through precise coding, you contribute to the financial stability and operational efficiency of healthcare providers, ultimately benefiting patient care.
• • This role offers the opportunity to work remotely nationwide, providing flexibility while contributing to a leading revenue cycle management solutions provider. You will be part of an award-winning company recognized for its excellence in the healthcare industry, including multiple "Best in KLAS" awards and other prestigious accolades.
• • You will be empowered to challenge the status quo and drive meaningful change within the revenue cycle management space, embodying Ensemble's O.N.E Purpose: Customer Obsession, Embracing New Ideas, and Striving for Excellence.
• • The role requires a proactive approach to identifying areas for improvement in coding processes and documentation, and the ability to translate complex coding guidelines into actionable recommendations for clients and internal teams.
• • You will be a key contributor to quality assurance efforts, ensuring that all outpatient coding adheres to the highest standards of accuracy and compliance, thereby minimizing risk and maximizing reimbursement for clients.
• • Your expertise will be vital in navigating the complexities of healthcare regulations and coding standards, ensuring that Ensemble Health Partners continues to deliver exceptional value to its clients.
• • This position offers a competitive salary range and opportunities for professional growth and development within a dynamic and supportive work environment.
• • You will be expected to adapt and modify medical billing procedures, protocols, and data management systems to meet specific operating requirements, demonstrating flexibility and problem-solving skills.
• • The ability to provide guidance and training to professional and technical staff in your area of expertise will be highly valued, contributing to the overall knowledge and skill development of the team.
• • Competency with Microsoft Office applications, including Word, Excel, and PowerPoint, is essential for reporting, data analysis, and presentations.
• • You will be an integral part of a team dedicated to innovation and excellence in revenue cycle management, contributing to Ensemble's reputation as a leader in the industry.