[Hiring] External Auditor Physician @Omega

Role Description

Under general supervision of client, Omega’s External Auditor Physician 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 Physician must be able to identify Physician query opportunities, write compliant queries, assess the accuracy of POA, discharge disposition and modifier assignments. External Auditor Physician performs data collection for quality and statistical purposes and reports the findings to Omega’s clients.

• Review inpatient, outpatient, or physician services medical records for accuracy of coding and data quality. Elements to be included in reviews can include:
• Inpatient/Observation Cases
• All diagnosis and procedure assigned ICD-10-CM and ICD-10 PCS codes
• Discharge disposition assigned
• 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.

Qualifications

• 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.
• Proficient personal computer skills.

Requirements

• No supervisory responsibility.
• This job operates in a remote home office environment. This role routinely uses standard office equipment such as computers and phones.
• Physical demands include standing, walking, sitting, using hands to handle objects, reaching, climbing stairs, balancing, stooping, kneeling, crouching, crawling, and talking or hearing.
• Must occasionally lift or move up to 25 pounds.
• Specific vision abilities required 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.
• Minimum travel required; up to 5%.

Education and Experience

• Associate’s Degree or equivalent training acquired through on-the-job experience.
• Must have at least two years of HIM experience, preferably as an Auditor.
• At least one year of auditing experience.
• Minimum of successful completion of an AHIMA approved Coding Certificate Program.

Additional Eligibility Qualifications

• CCS, CPC, CPC-P, CPC-H, RHIA or RHIT.

Security Access Requirements

• Access to Omega systems set forth in the “Standard Field Employee” profile.
• Microsoft Office.
• ADP.
• Oracle.
• Reveiwmate.
• E1- All Field Employees.
• Standard Employee.
• Standard Coder and Client Access based on client needs, determined by manager and granted by Audit Implementation Manager.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Employee may perform other duties as assigned.