Internal Auditor - Profee

Summary/Objective

Under the supervision of the Manager, Compliance and Quality Audit, Omega Internal Auditor will perform reviews of physician services medical records for coding accuracy and medical record documentation as it impacts the accuracy of ICD-10-CM, ICD-10-PCS codes 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.

• Review physician services medical records for accuracy of coding and data quality. Elements to be included in reviews can include:
  • All diagnosis assigned ICD‑10 CM codes
  • All CPT codes
  • All CPT E&M level codes
• Maintain auditing productivity based on Client and Omega agreed upon requirements.
• Complete Quality Review reports timely and submit to coder, Omega management, then to Client for review.
• Utilize all available official coding references to perform reviews, including but not limited to ICD‑10‑CM and ICD‑10‑PCS, CPT‑4, Coding Clinic, CPT Assistant, CMS guidelines and other official references.
• 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 those related to HIPAA and compliance.

• 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.
• Knowledge of coding conventions and rules established by the AMA, AHA and CMS for assignment of diagnostic and surgical procedural codes.
• Knowledge of JCAHO, coding compliance and HIPAA‑HITECH standards affecting medical records, reimbursement, and accreditation.
• Knowledge of documentation requirements to support coding and POA assignment.
• Extensive knowledge of medical terminology, anatomy, and physiology.
• Ability to prioritize and multi‑task in a multifaceted environment.
• Strong organizational skills and detail orientation.
• Self‑motivation, goal setting and meeting deadlines.
• Professional demeanor and strong interpersonal skills.
• Excellent presentation, verbal, and written communication skills.
• Relationship building with key business partners by developing personal credibility and trust.
• Maintains courteous professional relationships with employees at all levels.
• Excellent analytical, critical thinking and problem‑solving skills.
• Ability to identify deficiencies and upscale.
• Proficient personal computer skills and utilization of a variety of software applications.

None

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, 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.

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.

Minimum travel required; up to 5 %.

• Associate’s Degree or equivalent training acquired through on‑the‑job experience.
• At least three years of HIM coding experience.
• At…