Outpatient

Omega Healthcare Solutions•Boca Raton, FL

15d•$39 - $57

About The Position

This role involves conducting initial quality audits for assigned coding staff during their onboarding process for new projects or client assignments. The position requires reviewing medical records for accuracy in coding and data quality, ensuring compliance with regulatory requirements, coding guidelines, and payer rules. The Auditor/Educator will identify documentation gaps, evaluate the appropriateness of queries issued to physicians, analyze CDI performance data, and provide education and training to CDI staff, physicians, and other healthcare professionals on best practices.

Requirements

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 communicate with various healthcare professionals.

Responsibilities

Conduct initial quality audits for assigned coding staff during onboarding for new projects/client assignments.
Provide education to staff based on initial quality audit findings.
Review medical records for accuracy of coding and data quality, including CDI audit reviews.
Ensure documentation accurately reflects diagnoses, severity of illness, and risk of mortality.
Ensure documentation complies with regulatory requirements, coding guidelines, and payer rules.
Identify missed documentation opportunities, inconsistencies, and areas where documentation can be more specific or clarified.
Evaluate the appropriateness of queries issued to physicians.
Analyze data related to CDI performance, identify trends, and report findings to leadership.
Provide education and training to CDI staff, physicians, and other healthcare professionals on documentation best practices, coding guidelines, and regulatory requirements.
Review 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-DRG, MS-DRG, SOI, and ROM assignment for inpatient cases, Appropriateness of queries created.
Review 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.