Internal Auditor - Profee

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:

Professional Services

• 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 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.

• 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 elevate.
• Proficient personal computer skills and utilizing 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.

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