Quality Auditor Full Time

Company Details

• Ensemble Health Partners provides technology-enabled revenue cycle management solutions for healthcare organizations, including hospitals and health systems.
• The company offers end-to-end revenue cycle management services that support healthcare providers in managing financial operations across the entire revenue cycle.
• It combines expert teams, proven operational processes, and AI-powered technology to deliver streamlined and efficient revenue cycle solutions.
• Ensemble helps healthcare organizations improve financial performance, optimize revenue outcomes, and accelerate reimbursement processes.
• Its solutions are designed to address gaps in talent and technology within healthcare systems while improving operational efficiency.
• The company partners with hospitals and health systems to simplify and strengthen revenue cycle operations.
• Ensemble manages large volumes of patient revenue while helping healthcare providers enhance overall revenue cycle performance.
• The organization focuses on delivering measurable outcomes such as revenue improvement, operational efficiency, and cost savings.
• Ensemble promotes a people-first culture that emphasizes collaboration, innovation, and employee engagement.
• The company aims to create a frictionless revenue cycle that allows healthcare providers to focus more on delivering quality patient care.

Job Roles & Responsibilities

• By embodying our core purpose of customer obsession, new ideas, and driving innovation, and delivering excellence, you will help ensure that every touchpoint is meaningful and contributes to our mission of redefining the possible in healthcare.
• This role will assist Leadership with continued training, education and ongoing action plans to ensure quality is consistently met for existing teams in partnership with Quality Manager and Leadership Team.
• In addition, this role will assist Quality Manager and Leadership Team with onboarding support including user provisioning as required.

Essential Job Functions

• Customer Obsession – Consistently provide exceptional experience 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.
• Assesses the Quality Assurance process and actively looks for opportunities to increase efficiency and proactively brings them to Leadership’s attention.
• Evaluate operational and management Quality Audit policies/procedures and provide input into the annual review workplan.
• Performs Quality reviews across multiple clients, working in a variety of host systems.
• Coordinate with service line leaders and partner with upper-level Leadership to identify areas of risk and assist leadership in developing a quarterly/annual review plan.
• Develop a thorough understanding of business processes in scope for assigned reviews and document the processes.
• Perform account-level reviews to ensure consistency with best practices including but not limited to Quality.
• Conduct audits to confirm implementation and effectiveness of policies/procedures.
• Perform reviews to measure compliance with policies, procedures, workflow, and other applicable requirements.
• Identify and document operational, compliance, and quality risks and make recommendations to mitigate risks.
• Prepare and assist in presenting quality reports of review findings and recommendations to direct leadership for review and approval.
• Participate in pre- and post-review meetings, providing support and recommendations for issues presented.
• Ensure past review recommendations are implemented in the current review process.
• Maintain current knowledge of laws/regulations regarding medical necessity, clinical documentation, compliance standards, and other clinical or business matters related to the service line they are supporting.

Ideal candidate profile

• Graduate in any discipline (B.Sc./M.Sc. Nursing, B. Pharm, M. Pharm, or Life Sciences education is preferred)
• Certification in Medical Billing and Coding (CPC, CCS, or equivalent) preferred
• 3+ years of overall experience with 2+ years of experience in Quality Analysis within the healthcare / RCM domain
• Strong understanding of end-to-end RCM processes including Charge Entry, Payment Posting, Denial Management, and AR Follow-up
• Knowledge of HIPAA and healthcare compliance standards
• Proficiency in using billing software (e.g., Epic, Athena, Kareo) and QA tools
• Excellent communication skills for feedback and reporting
• Attention to detail with strong analytical and problem-solving skills
• Ability to work independently and in a team environment

Job Competencies

• 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 as needed, to achieve success; focuses on the results of the team, not the achievements of one person. It’s “All for One and One for All”.
• Accountability – Accepts personal responsibility and/or consequences of failure and successes, delivering on commitments and refocusing effort when needed. Someone who is willing to step up and own it.
• Time Management – Effectively manages personal time and resources to ensure that 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.