Auditor/Educator In/Outpatient

Omega • Boca Raton, FL

9d

About The Position

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:
CDI audit reviews
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.
• 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
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
Qualifications for Internal Candidates
Employee must be fluent in auditing facility inpatient, Outpatient is a plus. Will be trained in DRG appeal writing. Must be experienced in Word and Excel. CDI credential is a plus.

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.
• Employee must be fluent in auditing facility inpatient
• Must be experienced in Word and Excel.

Nice To Haves

• Outpatient auditing experience is a plus
• CDI credential is a plus.

Responsibilities

• Conduct initial quality audits for assigned coding staff during onboarding for new projects/clients.
• Provide education to staff based on initial quality audit findings.
• Review medical records for accuracy of coding and data quality.
• Review medical records 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.
• 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.

What This Job Offers

• Education Level: No Education Listed