External Auditor In​/Outpatient

Lead Compliance and Quality Audit Manager

Grade

L

Location

Remote

Band

1D

Summary/Objective

Under general supervision of client, Omega’s External Auditor In/Outpatient 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 MS-DRG assignment and ICD-10-CM and CPT-4/HCPCS codes driving the APC assignment. The External Auditor In/Outpatient must be able to identify Physician query opportunities, write compliant queries, assess the accuracy of POA, discharge disposition and modifier assignments.

External Auditor In/Outpatient performs data collection for quality and statistical purposes and reports the findings to Omega’s clients.

Essential Job Functions

Review inpatient, outpatient, or physician services medical records for accuracy of coding and data quality. 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 Outpatient Cases (ER, SDS, Ancillary)

All diagnosis and procedure assigned ICD-10-CM and ICD-10 PCS codes

All CPT assigned codes

Modifier use and assignment

APC assignment Professional Services

All diagnosis codes assigned ICD-10 CM

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 Client for review.

Utilize all available official references to perform reviews: to include but not limited to International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM), the Current Procedural Terminology (CPT-4) Official Coding Guidelines, Coding Clinic, CPT Assistant, CMS guidelines, etc.

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

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 leadership, mentoring, and 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 take corrective action.

Supervisory Responsibility

No

This job operates in a remote home office environment. This role routinely uses standard office equipment such as computers and phones.

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 p.m. This position occasionally requires long hours and weekend work.

Travel

Minimum…