External Auditor In/Outpatient

Omega Healthcare Management Services Pvt. Ltd.; Boca Raton, Northern (FL, KY); Hybrid; USD 90,000 - 130,000; Full time

Job summary

Omega Healthcare Management Services is seeking a Lead Compliance and Quality Audit Manager to perform reviews of inpatient, outpatient, and physician services medical records for coding accuracy and data quality. The role requires identifying physician query opportunities, assessing POA and modifier accuracy, and supporting MS-DRG and APC assignments.

This is a full-time remote position with a focus on compliance and quality audits.

Qualifications

• Associate’s Degree or equivalent training.
• Must have at least two years of HIM experience, preferably as an Auditor.
• At least one year of auditing experience.
• Successful completion of an AHIMA approved Coding Certificate Program.
• CCS, CPC, CPC-P, CPC-H, RHIA or RHIT certifications are desirable.

Responsibilities

• Review inpatient, outpatient, or physician services medical records for accuracy of coding and data quality.
• Assess coding accuracy of ICD-10-CM, ICD-10-PCS, CPT-4/HCPCS codes and APC assignments.
• Identify physician query opportunities and write compliant queries.
• Ensure POA, discharge disposition and modifier accuracy.
• Prepare Quality Review reports and communicate findings to clients.

Education

AHIMA Coding Certificate Program

Associate’s Degree or equivalent training

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

Job description

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 travel required; up to 5%

Required 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.

Preferred Education and Experience

None.

Additional Eligibility Qualifications

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

Security Access Requirements

In addition to the specific security access required by the employee’s client engagement, the employee will have access to the Omega systems set forth in the “Standard Field Employee” profile.

Microsoft Office

ADP

Oracle

E1- All Field Employees

Standard Employee

Standard

Coder and Client Access based on client needs. Determined by manager and granted by Audit Implementation Manager

Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcarealso prohibits harassment of applicants or employees based on any of these protected categories.

Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at [e-mail].

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. Employees may perform other duties as assigned.

About Us

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. The company works with providers, payers, life science companies, medical device manufacturers, health technology firms, researchers, and industry partners to amplify teams with robust technology, specialty expertise, and operational support. Omega Healthcare serves more than 350 healthcare organizations with 35,000 skilled workers in the United States, India, Colombia, and the Philippines. For more information, visit www.omegahms.com

We offer a comprehensive benefits package that may include health, dental, and vision coverage, voluntary insurance options, a 401(k) plan with employer match, professional development opportunities, paid time off, and holiday pay. Eligible employees may also have the opportunity to participate in bonus programs, commissions, or other variable incentive plans. Benefits and incentive eligibility may vary based on position, location, and tenure.

AAP/EEO Statement

Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcarealso prohibits harassment of applicants or employees based on any of these protected categories.

Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at [e-mail] .