Compliance & Quality Audit Manager

Summary/Objective

This position will perform reviews of inpatient and outpatient or professional services 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 assignment and ICD-10 CM and CPT-4/HCPCS codes driving the APC assignment. This position will be able to identify Physician query opportunities, assess the accuracy of POA, discharge disposition and modifier assignments.

Performs data collection for quality and statistical purposes and reports the finding to the Client and to Omega management. Must have the ability to independently perform client presentations as needed and represent the HIM QA Compliance team internally and/or externally.

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

Independently completed reports for submission to the Client. Elements to be included in reviews can include:

• All diagnosis and procedure assigned ICD-10-CM and ICD- 10 PCS codes
• Assigned Present on Admission (POA) indicators
• APR, SOI, and ROM assignment for inpatient cases

• All diagnosis and procedure assigned ICD-10-CM and ICD-10 PCS codes
  • All CPT assigned codes
  • Modifier use and assignment
  • APC assignment

• All diagnosis codes
  • All CPT codes
  • All E&M Leveling codes
• Maintain auditing productivity based on Client and Omega agreed-upon requirements
• Complete Quality Review reports timely and submits to Omega management (subsequently to Client) for review.
• May occasionally be selected to work with the Omega Compliance Team to develop and provide coder/coding training and education sessions, group, or one-on-one sessions, as needed, based on results of the Coding Quality Reviews.
• Utilize all available official references to perform reviews: to include but not limited to International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM), the Current Procedural Terminology (CPT-4) Official Coding Guidelines, Coding Clinic, CPT Assistant, CMS guidelines, etc.
• Manage assigned projects including identifying scope of project, assigning audit staff, identifying and resolving issues with project timelines, parameters and other areas, monitoring and maintaining quality.

Ability to prioritize and multi-task in a multifaceted environment.

Demonstrate strong organizational skills and be detail oriented.

Demonstrate ability to self-motivate, set goals, and meet deadlines.

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 take corrective action.

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.

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

At least three years of HIM experience within an Auditing capacity.

None

CCS, CPC, CCS-P, COC, CIC, RHIA or RHIT

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…