RN/LPN, Nurse Auditor

Thank you for considering a career at Ensemble!

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. 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!

O.N.E Purpose:

• Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.

• Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.

• Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

The Opportunity:

Responsibilities:

The Nurse Auditor I performs charge audits and potential client assessments as assigned by management.

This role is responsible for timely resolution of all incorrect and/or missing charges to prevent revenue loss and to ensure compliance requirements are met.

Identifies opportunities for any additional documentation needs to support charges captured.

Conducts regular audits to look for opportunities of missing revenue and reports to management.

Fulfill audits requests by reviewing clinical documentation, identify trends for missing and/or incorrect charges and report on findings.

Applies clinical knowledge to educate stakeholders on standards for documentation and charge capture practices and to look for opportunities of improvement based on audit outcomes.

Responsible for reviewing Injection & Infusion work queues in Epic.

Resolve prebill and post bill missing and error charges identified by Opera Solutions software to prevent revenue loss and ensure accurate and timely billing of services provided.

Support the organization in meeting its financial goals. Travel to clients’ sites as needed to conduct assessments and to provide education and training related to findings.

Respond to clients’ questions and audit requests in a timely manner.

Meet and or exceed the department productivity and quality standards.

Review CMS, OIG, and other pertinent government websites to keep abreast of all charge capture guidelines & how they may impact revenue.

Maintain thorough understanding of government rules and regulations, generally accepted auditing standards and common audit procedures and techniques.

Other Preferred Knowledge, Skills and Abilities:

Working knowledge of CPT/HCPCS/Revenue codes, charge capture and billing best practices, and government and non-government reimbursement guidelines.

Strong organization skills.

Highly motivated and self-starter with ability to complete assignments within time constraints and deadlines.

Ability to thrive in a dynamic & fast paced work environment.

Experience in physician and hospital operations, compliance and provider relations

Minimum Education:

Current RN or LPN Licensure

Certifications:

Candidate must have and keep current at least one of the following professional certifications or other approved job relevant certification:

CCDI (Certified Clinical Documentation Improvement)

CCS (Certified Coding Specialist)

RHIA (Registered Health Information Administrator)

RHIT (Registered Health Information Technician)

COC (Certified Outpatient Coder)

PMP (Project Management Professional)

CPMA (Certified Professional Medical Auditor)

Join an award-winning company

Five-time winner of “Best in KLAS” 2020-2022, 2024-2025

Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024

22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024

Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024

Clarivate Healthcare Business Insights (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

Great Place to Work certified 2023-2024

• Innovation

• Work-Life Flexibility

• Leadership

• Purpose + Values

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:

• Associate Benefits – We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.

• Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.

• Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.

• Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Ensemble is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact TA@ensemblehp.com.

This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range.

Employment Disclaimers – Ensemble