Outpatient

Omega Healthcare Management Services•Boca Raton, FL

14d

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 primary focus is to provide education based on audit findings, review medical records for accuracy in coding and data quality, and ensure documentation supports diagnoses, severity of illness, and risk of mortality. The position requires ensuring compliance with regulatory requirements, coding guidelines, and payer rules, while also identifying opportunities for improved documentation specificity. A key responsibility includes evaluating the appropriateness of queries issued to physicians and analyzing CDI performance data to identify trends and report findings to leadership. Additionally, the role entails providing education and training on documentation best practices, coding guidelines, and regulatory requirements to CDI staff, physicians, and other healthcare professionals.

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.
CCS, or CIC, CPC and COC certifications.

Responsibilities

Conduct initial quality audits for assigned coding staff during onboarding.
Provide education to staff based on initial quality audit findings.
Review medical records for accuracy of coding and data quality.
Review medical records, including clinical notes, lab results, and other diagnostic information, to 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, ensuring they are supported by clinical evidence and aligned with coding guidelines.
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.
Assign all diagnosis and procedure codes (ICD-10-CM and ICD-10 PCS) for inpatient/observation cases.
Assign discharge disposition for inpatient/observation cases.
Assign Present on Admission (POA) indicators for inpatient/observation cases.
Assign APR-DRG, MS-DRG, SOI, and ROM for inpatient cases.
Assess the appropriateness of queries created for inpatient/observation cases.
Assign all diagnosis and procedure codes (ICD-10-CM and ICD-10 PCS) for outpatient cases (ER, SDS, Ancillary).
Assign all CPT codes for outpatient cases.
Ensure correct modifier use and assignment for outpatient cases.
Assign APC for outpatient cases.