Description
Ensemble Health Partners 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
The Outpatient Coding Auditor integrates medical coding principles and objectivity in the performance of outpatient coding audit activities. Draws on ICD10CM, CPT and CMS coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues, and quality concerns. Under indirect supervision, the Coding Auditor will audit the quality of all outpatient work types to assure appropriateness and accuracy of Diagnoses, CPT, HCPCS, CCI edits, modifier assignment in accordance with ICD10 CM, CPT, HCPCS, CPT Assistant, Coding Clinic, Center of Medicare and Medicaid (CMS) guidelines, and National Correct Coding Initiatives (NCCI).
Job Responsibilities
- The audit professional integrates medical coding principles and objectivity in the performance of coding audit activities. Draws on ICD10CM, HCPCS, NCCI, and CMS coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues, and quality concerns.
- Participates in client system education to gain the knowledge necessary to audit client accounts in ensuring that the coding is supported by the patient's clinical documentation, coding/cdi guidelines and other regulatory standards/guidelines as appropriate.
- Maintain meticulous documentation, spreadsheets, account, and claim examples of root cause issues. Performs searches of governmental, payor-specific, hospital-specific, regulatory body, and literature rules, regulations, guidelines to identify and coding and billing requirements to make recommendations to client.
- Assist in the development and coordination of the executive summary reports, education and training client coding companion as it relates to the outcomes of the coding audit.
- Meet established productivity standards for coding audits & coding certification requirement.
- Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations.
- Provides excellent customer service, in an organized and efficient manner, while maintaining a positive attitude.
Experience
- 3+ years of outpatient coding experience.
- 3+ years of auditing experience.
- Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements.
- Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.
- Knowledge of current and developing issues and trends in medical coding procedures requirements.
- Ability to clearly communicate medical information to professional practitioners and/or the general public.
- Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements.
- Ability to provide guidance and training to professional and technical staff in area of expertise.
- Competent with the use of all Microsoft Office applications, including Word, Excel, and Power Point.
Required Certifications
Candidate 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).