Auditor/Educator In/Outpatient

Omega Healthcare Management Services • Boca Raton, FL

12d

About The Position

Description 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 me dical reco rds, 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

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, Outpatient is a plus.
• Must be experienced in Word and Excel.

Nice To Haves

• CDI credential is a plus.

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 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

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed