Auditor/Educator In/Outpatient

Omega Healthcare Management Services; Boca Raton (FL); On-site; USD 60,000 - 85,000; Full time

Job summary

Omega Healthcare Management Services in Boca Raton is looking for a professional to conduct quality audits and provide education for coding staff. The role emphasizes understanding clinical documentation and regulatory compliance, ensuring accurate coding.

The ideal candidate will have strong clinical knowledge, be familiar with ICD coding systems, and possess excellent communication skills. CDI credentials are preferred and training in DRG appeal writing will be provided.

Qualifications

• Strong understanding of disease processes, clinical conditions, and medical terminology.
• Familiarity with ICD-10-CM/PCS, CPT, and other relevant coding systems.
• Experience in clinical documentation integrity, including chart review and query writing.
• Ability to analyze data, identify trends, and make recommendations for improvement.
• Excellent written and verbal communication skills to effectively interact with healthcare professionals.

Responsibilities

• Conduct initial quality audits during onboarding for new projects.
• Review medical records for accuracy of coding and data quality.
• Provide education based on audit findings to coding staff.
• Ensure compliance with regulatory requirements and coding guidelines.
• Identify missed documentation opportunities and areas for improvement.

Skills

Clinical Knowledge

Coding Knowledge

CDI Experience

Analytical Skills

Communication Skills

Education

CDI (Clinical Documentation Integrity); CDIP (AHIMA), CCDS (ACDIS) or CDEI (AAPC)

Tools

Word

Excel

Job description

Essential Job Functions

Initial Audit and Education

• For assigned coding staff, conduct initial quality audits as they go through onboarding process for new project/client assignment, and provide education to staff based on initial quality audit findings. Review medical records for accuracy of coding and data quality. Elements included in reviews may include:
• Auditing: Reviewing medical records, including clinical notes, lab results, and other diagnostic information, to ensure documentation accurately reflects diagnoses, severity of illness, and risk of mortality.
• Compliance: Ensuring documentation complies with regulatory requirements, coding guidelines, and payer rules.
• Identifying Gaps: Identifying missed documentation opportunities, inconsistencies, and areas where documentation can be more specific or clarified.
• Query Review: Evaluating the appropriateness of queries issued to physicians, ensuring they are supported by clinical evidence and aligned with coding guidelines.
• Data Analysis: Analyzing data related to CDI performance, identifying trends, and reporting findings to leadership.
• Education and Training: Providing education and training to CDI staff, physicians, and other healthcare professionals on documentation best practices, coding guidelines, and regulatory requirements.

Skills and Qualifications

• Clinical Knowledge: Strong understanding of disease processes, clinical conditions, and medical terminology.
• Coding Knowledge: Familiarity with ICD-10-CM/PCS, CPT, and other relevant coding systems.
• CDI Experience: Experience in clinical documentation integrity, including chart review and query writing.
• Analytical Skills: Ability to analyze data, identify trends, and make recommendations for improvement.
• Communication Skills: Excellent written and verbal communication skills to effectively communicate with various healthcare professionals.
• All diagnosis and procedure assigned ICD-10-CM and ICD-10-PCS codes.
• Appropriateness of queries created.

Outpatient Cases (ER, SDS, Ancillary)

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

Qualifications for Internal Candidates

Employee must be fluent in auditing facility inpatient, Outpatient is a plus. Will be trained in DRG appeal writing. Must be experienced in Word and Excel. CDI credential is a plus.

Qualifications

Must have CDI (Clinical Documentation integrity); CDIP(AHIIMA), CCDS (ACDIS) or CDEI (AAPC)