Internal Auditor - Profee

Omega Healthcare Management Services Pvt. Ltd.; Boca Raton (FL); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Health insurance

401(k) plan with employer match

Paid time off

Job summary

Omega Healthcare Management Services Pvt. Ltd. is seeking an Internal Auditor to review physician services for coding accuracy, ensuring high standards of documentation and compliance.

A successful candidate will possess knowledge of ICD-10-CM and CPT-4 coding, alongside strong analytical skills and proficiency in Microsoft Excel.

We offer a competitive benefits package that includes health, dental, 401(k) plans, and professional development opportunities.

Qualifications

• 3 years of HIM coding experience required.
• 2 years total audit experience with 1 year of current audit experience.
• Intermediate to advanced technical knowledge of HIM systems.

Responsibilities

• Review medical records for coding accuracy.
• Complete Quality Review reports and communicate issues.
• Utilize coding references and client-specific guidelines.

Skills

ICD-10-CM knowledge

CPT-4 coding

Microsoft Excel

Regulatory knowledge

Analytical skills

Interpersonal skills

Education

Associate’s Degree

AHIMA/AAPC Coding Certificate

Tools

Epic

Cerner

Microsoft Office Suite

Job description

Summary/Objective

Under the supervision of the Manager, Compliance and Quality Audit, Omega Internal Auditor will perform reviews of physician services medical records for coding accuracy and medical record documentation as it impacts the accuracy of ICD-10-CM, ICD-10-PCS codes and ICD-10 CM and CPT-4/HCPCS codes driving the APC assignment. The Auditor must also be able to identify coding trends, physician query opportunities, assess the accuracy of POA, discharge disposition and modifier assignments. Utilizing audit software tools or manual Excel templates to perform data collection for quality and statistical purposes for reporting and education to the Coder, Client, and Omega management.

Essential Job Functions

• Review physician services medical records for accuracy of coding and data quality. Elements to be included in reviews can include:
  • All diagnosis assigned ICD‑10 CM codes
  • All CPT codes
  • All CPT E&M level codes
• Maintain auditing productivity based on Client and Omega agreed upon requirements.
• Complete Quality Review reports timely and submit to coder, Omega management, then to Client for review.
• Utilize all available official coding references to perform reviews, including but not limited to ICD‑10‑CM and ICD‑10‑PCS, CPT‑4, Coding Clinic, CPT Assistant, CMS guidelines and other official references.
• 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 those related to HIPAA and compliance.

Key Success Indicators/Attributes

• 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.
• Knowledge of coding conventions and rules established by the AMA, AHA and CMS for assignment of diagnostic and surgical procedural codes.
• Knowledge of JCAHO, coding compliance and HIPAA‑HITECH standards affecting medical records, reimbursement, and accreditation.
• Knowledge of documentation requirements to support coding and POA assignment.
• Extensive knowledge of medical terminology, anatomy, and physiology.
• Ability to prioritize and multi‑task in a multifaceted environment.
• Strong organizational skills and detail orientation.
• Self‑motivation, goal setting and meeting deadlines.
• Professional demeanor and strong interpersonal skills.
• Excellent presentation, verbal, and written communication skills.
• Relationship building with key business partners by developing personal credibility and trust.
• Maintains courteous professional relationships with employees at all levels.
• Excellent analytical, critical thinking and problem‑solving skills.
• Ability to identify deficiencies and upscale.
• Proficient personal computer skills and utilization of a variety of software applications.

Supervisory Responsibility

None

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, 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 5:00 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.
• At least three years of HIM coding experience.
• At least two years total audit experience with one year of current audit experience.
• Minimum successful completion of an AHIMA/AAPC approved Coding Certificate Program.
• Intermediate level knowledge of Microsoft Office Suite.
• Intermediate to advanced technical knowledge of HIM electronic medical systems and software tools such as Epic, Cerner, Allscripts, Optum 360, BOX, ReviewMate, etc.

Preferred Education and Experience

Five years of HIM experience as a compliance auditor.

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 set forth in the “Standard Field Employee” profile.

• Microsoft Office
• ADP
• Oracle
• ReviewMate

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.

Benefits

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 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 Healthcare also 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].