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Ensemble Health Partners

End-to-end revenue cycle management for hospitals

DRG Validation Coding Auditor

Clinical Support & Patient AdministrationConfirmed live in the last 24 hours
Full-timeRemote in USA

About the Job

Requirements

  • Five or more years of coding experience.
  • Three or more years of facility coding audit experience, such as DRG and APC validation.
  • Proficiency with multiple electronic medical records, encoders, and the Microsoft Office suite.
  • Knowledge of HIPAA regulations and ability to maintain strict confidentiality of patient and client information.
  • Ability to read, write, and effectively communicate in English.
  • Ability to understand medical and surgical terminology.
  • Ability to use artificial intelligence as a tool for exploring improved processes and reducing friction.
  • Must maintain at least one current professional certification: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT).
  • Must reside in the United States and be authorized to work there.
  • Must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Responsibilities

  • Perform documentation and coding audits for acute inpatient services, identifying coding errors, compliance and education opportunities, and ways to optimize reimbursement while ensuring diagnosis and procedure codes and supporting documentation accurately reflect services and comply with ethical coding standards, guidelines, and regulatory requirements.
  • Independently review and interpret medical records, applying in-depth coding knowledge to identify billing, coding, documentation, and quality concerns and research requirements for compliant recommendations.
  • Apply reimbursement guidelines, particularly for DRG payment systems such as MS-DRG, APR-DRG, and Tricare.
  • Conduct DRG coding and clinical reviews to verify coding accuracy, DRG assignment, and clinical indicators against coding and documentation guidelines, ensuring the DRG reflects patient severity and hospital resources used.
  • Assess whether clinical documentation supports coded diagnoses and procedures and whether the medical record justifies the assigned DRG.
  • Combine medical record coding guidelines, clinical principles, and industry trends to explain recommended changes to coders, working with Clinical Documentation Integrity specialists to identify documentation and query opportunities.
  • Meet productivity and quality goals set by audit leaders.
  • Write clear, accurate, concise audit recommendations and provide feedback and education to acute inpatient coders, referencing current ICD-10-CM/PCS Official Coding Guidelines and AHA Coding Clinics.
  • Complete acute inpatient coding audits accurately and on time, meeting client turnaround and audit quality expectations.
  • Maintain current professional certifications, continuing education units, and up-to-date knowledge of coding guidelines.
  • Complete required education through internal applications, compliance training, and other mandatory educational programs.
  • Use proprietary systems and encoder tools accurately and efficiently to make audit determinations and generate audit recommendations through workflow processes.
  • Analyze claims over a 30-day lookback to identify potential overpayments or underpayments and discrepancies between billed DRGs and services provided.
  • Use ICD-10 coding expertise, clinical guidelines, and proprietary tools to substantiate conclusions, and stay informed about changes to acute inpatient coding regulations and reimbursement policies.
  • Identify potential additional recovery or compliance concerns outside the normal scope and assist with developing concepts, process improvements, and tools.

Desired Qualifications

  • Certified Coding Specialist (CCS) certification is preferred.

About the Company

Ensemble Health Partners

End-to-end revenue cycle management for hospitals

Ensemble Health Partners provides end-to-end revenue cycle management for hospitals and health systems. It handles the entire process from patient intake to final payment, with teams and technology embedded into the provider's operations and a revenue model tied to performance improvements. The company uses its proprietary EIQ platform (analytics, AI, and workflow automation) to optimize revenue cycle processes, reduce insurance denials, and speed cash collection, managing more than $39 billion in net patient revenue. Its approach differentiates it by being a true managed-services partner with full accountability for financial outcomes and a track record of meeting initial client goals. The overarching goal is to improve healthcare providers’ financial performance so they can focus on patient care.

Company size
5,001-10,000
Company stage
Not listed
Total funding
Not listed
Headquarters
Cincinnati, OH
Founded
2014

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