Inpatient Auditor

Omega Healthcare Management Services Pvt. Ltd.; United States; Vor Ort; USD 70.000 - 110.000; Vollzeit

Zusammenfassung

Omega Healthcare Management Services Pvt. Ltd. is seeking a qualified CDI Auditor with a minimum of three years of inpatient and outpatient auditing experience to join our clinical documentation integrity team.

You will conduct initial quality audits during onboarding, review records for accuracy of diagnoses, severity and risk of mortality, and provide education to staff based on findings. You will evaluate the appropriateness of physician queries, analyze CDI performance data, and work with

Qualifikationen

• Minimum 3 years inpatient and outpatient auditing experience.
• Strong working knowledge of Epic and advanced Excel skills.
• Experience using other healthcare systems.
• Knowledge of ICD-10-CM/PCS, CPT coding systems.

Aufgaben

• Perform initial quality audits for onboarding and educate staff based on findings.
• Review medical records for accuracy of diagnoses, severity, and risk of mortality.
• Ensure documentation complies with regulatory requirements and payer rules; identify gaps.
• Evaluate physician queries for evidence and alignment with coding guidelines.
• Analyze CDI performance data and report findings to leadership.
• Provide education and training on documentation and coding guidelines.

Kenntnisse

Analytical skills

Communication

Clinical knowledge

Data interpretation

Tools

Epic

Excel

Other healthcare systems

Jobbeschreibung

The role requires a candidate with a minimum of 3years of inpatient (IP) and outpatient (OP) auditing experience. Candidates should also have strong working knowledge of Epic, advanced Excel skills, and experience using other relevant healthcare systems.

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
• Assigned Present on Admission (POA) indicators
• APR-DRG, MS-DRG, SOI, and ROM assignment for inpatient cases
• Appropriateness of queries created

Outpatient Cases (ER, SDS, Ancillary)

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