Internal Auditor - In/Outpatient

Summary/Objective
Under the supervision of the Manager, Compliance and Quality Audit, Omega Internal Auditor will perform reviews of inpatient and outpatient 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 and ICD-10 CM and CPT-4/HCPCS codes driving the APC 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 Omega management. 

Essential Job Functions

• Review inpatient and outpatient medical records for accuracy of coding and data quality. 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 

     Outpatient Cases (ER, SDS, Observation, Ancillary)

• All diagnosis and procedures assigned ICD-10-CM and ICD-10 PCS codes
• All CPT assigned codes
• APC assignment
• Modifier use and assignment
• E/M facility level codes (if required)
• Infusions and injections (if required)
• 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.
• Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance.

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.
• 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.

Supervisory Responsibility

None

Work Environment

This job operates in a remote home office environment. This role routinely uses standard office equipment such as computers and phones. Auditor is responsible for assuring they have all the necessary equipment (including reliable high-speed internet) to perform the required job duties to meet Omega standards, such as a dual monitor. Office environment should be away from distractions and free from noise during working hours.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; and talk or hear. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus.

Position Type/Expected Hours of Work

This is a full-time position. Days and hours of work are generally Monday through Friday, 8:00 a.m. to 5:00 p.m. This position occasionally requires long hours and weekend work.

Travel

Minimum travel required; up to 5%

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.
• Minimum of successful completion of an AHIMA/AAPC approved Coding Certificate Program.
• 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 experience will vary based on client’s needs.

Preferred Education and Experience

Five years of experience as a compliance auditor.

Additional Eligibility Qualifications

CCS, CPC, CPC-P, CPC-H, RHIA or RHIT

Security Access Requirements

In addition to the specific security access required by the employee’s client engagement, the employee will have access to the Omega systems set forth in the “Standard Field Employee” profile.

AAP/EEO Statement

Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcare also prohibits harassment of applicants or employees based on any of these protected categories.

Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at employeerelationsus@omegahms.com.

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.