Position Name: Nurse Auditor
Experience: 1-3 Years

About Us
Ensemble Health Partners is the single solution for a frictionless revenue cycle. Founded in 2014, we set out to redefine what is possible in healthcare by empowering people to be the difference.
Today, Ensemble supports revenue cycle excellence for hundreds of hospitals across the United States. From talent to technology, we provide a comprehensive healthcare revenue cycle management solution that enables industry leaders to achieve sustained performance and measurable outcomes.

Ensemble Health Partners India, the company's Global Capability Center with its flagship facility in Hyderabad, serves as a hub for certified professionals supporting critical revenue cycle functions across the organization.

Position Summary
This advanced clinical auditor position is responsible for reviewing assigned work queues, performing charge audits, resolving incorrect and/or missing charges on pre-bill and post-bill accounts, monitoring revenue loss reports, and identifying documentation opportunities to support accurate charge capture.




The role includes reviewing clinical documentation, identifying trends related to missing or incorrect charges, and managing Injection & Infusion work queues in Epic. The Nurse Auditor will also resolve pre-bill and post-bill charge errors identified through Opera Solutions software and collaborate with stakeholders to ensure documentation and charge capture practices meet established standards.

Job Responsibilities
Medical Necessity Evaluation
Acute care experience and Utilization Review or Case Management experience are typically required.
Robust understanding of medical necessity criteria (InterQual/MCG), coding (DRGs), and insurance policies.
Review denied claims, patient charts, provider notes, and diagnostic tests against evidence-based criteria to determine whether services met coverage requirements.
Denial Investigation
Investigate reasons for insurance denials by reviewing Expla

📌 Nurse Auditor (Hyderabad)
🏢 ensemble global
📍 Hyderabad