Homeoffice Internal Auditor - Inpatient at Omega Healthcare Management Services Private Limited
Omega Healthcare Management Services Private Limited · Boca Raton, United States Of America · Remote
- Professional
Under the supervision of the Manager, Compliance and Quality Audit, Omega Internal Auditor will perform reviews of inpatient medical records for coding accuracy and medical record documentation as it impacts the accuracy of ICD-10-CM, ICD-10-PCS codes driving the MS-DRG/APR-DRG assignment. The Auditor must also be able to identify coding trends, physician query opportunities, assess the accuracy of POA, discharge disposition and modifier assignments. Utilizing audit software tools or manual Excel templates to perform data collection for quality and statistical purposes for reporting and education to the Coder, Client and internal management.
Qualifications
Essential Job Functions
Review inpatient medical records for accuracy of coding and data quality. Provide detailed education and feedback to coding staff.
Elements to be included in reviews can include:
Inpatient Cases
All diagnosis and procedures assigned ICD-10-CM and ICD- 10 PCS codes
Validation of MS-DRG/APR-DRG
APR, SOI, and ROM assignment
Query opportunities
Discharge disposition assigned
Assigned Present on Admission (POA) indicators
Develop PowerPoint presentations based on audit findings and deliver the coder education via zoom meetings one night a week.
Maintain auditing productivity based on Client and Omega agreed upon requirements.
Complete Quality Review reports timely and submits to coder, Omega management (subsequently to Client) for review.
Utilize all available official coding references to perform reviews, to include but not limited to International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM and ICD-10-PCS), the Current Procedural Terminology (CPT-4) Official Coding Guidelines, Coding Clinic, CPT Assistant, CMS guidelines, etc.
Utilize client specific coding policies and guidelines in conjunction with Official Guidelines to perform reviews.
Communicate effectively with supporting staff and Omega point-of-contact(s).
Provide information regarding work progress, actions and issues in a timely and effective manner.
Must be skilled in Microsoft Excel and PowerPoint.
Key Success Indicators/Attributes
Extensive knowledge of ICD-10-CM, ICD -10 PCS and CPT-4 coding and MS-DRG and APR-DRG assignment.
Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing in addition to those that are state-specific.
Knowledge of coding conventions and rules established by the American Medical Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS), for assignment of diagnostic and surgical procedural codes.
Knowledge of JCAHO, coding compliance and HIPAA-HITECH standards affecting medical records and the impact on reimbursement and accreditation.
Knowledge of documentation requirements to support coding and POA assignment is required.
Extensive knowledge of medical terminology, anatomy and physiology.
Extensive knowledge on providing coder education in clear concise manner.
Ability to prioritize and multi-task in a multifaceted environment.
Demonstrate strong organizational skills and detail oriented.
Demonstrate ability to self-motivate, set goals, and meet deadlines.
Demonstrate professional demeanor and strong interpersonal skills.
Demonstrate excellent presentation, verbal and written communication skills.
Ability to develop and maintain relationships with key business partners by building personal credibility and trust.
Maintains courteous and professional working relationships with employees at all levels of the organization.
Demonstrate excellent analytical, critical thinking and problem-solving skills.
Ability to identify deficiencies and escalate.
Proficient personal computer skills and utilizing a variety of software applications.
Required Education and Experience
Associate’s Degree or equivalent training acquired through on-the-job experience.
At least three years of HIM coding experience.
At least two years total audit experience with one year of current audit experience.
Must have intermediate level knowledge of Microsoft Office Suite.
Intermediate to advance technical knowledge of HIM electronic medical systems and software tools, such as Epic, Cerner, Allscripts, Optum 360, BOX, ReviewMate, etc. Specific system’s experience will vary based on client’s needs.
Preferred Education and Experience
Five years of HIM experience as a compliance auditor.
Additional Eligibility Qualifications
CCS, CPC, CPC-P, CPC-H, RHIA or RHIT
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Employee may perform other duties as assigned.
