Apply on Employer Site

Omega Healthcare Management Services · 1 week ago

Internal Auditor - In/Outpatient

Boca Raton, FL, United States

Full-time

Onsite

Mid Level

3+ years exp

Omega Healthcare Management Services is a leading provider in healthcare management, and they are seeking an Internal Auditor to perform reviews of inpatient and outpatient medical records for coding accuracy and documentation compliance. The role involves utilizing audit software and Excel for data collection, identifying coding trends, and ensuring adherence to coding guidelines and regulations.

Hospital & Health Care

Responsibilities

Review inpatient and outpatient medical records for accuracy of coding and data quality. Elements to be included in reviews can include:

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

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

Qualification

ICD-10-CMICD-10-PCSCPT-4MS-DRGAudit experienceMicrosoft ExcelHIM electronic systemsMedical terminologyAnalytical skillsCommunication skillsOrganizational skillsInterpersonal skillsProblem-solving skills

Required

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

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

Preferred

Five years of experience as a compliance auditor

Company

Omega Healthcare Management Services

Glassdoor3.7

Founded in 2003, Omega Healthcare Management Services® (Omega Healthcare) empowers healthcare to thrive via intelligent solutions that optimize revenue cycle operations, administrative workflows, care coordination, and clinical research on a global scale.

Founded in 2003

Boca Raton, Florida, US

10001+ employees