Compliance & Quality Audit Manager

Omega Healthcare Solutions • Boca Raton, FL

1d • Remote

About The Position

This position will perform reviews of inpatient and outpatient or professional services medical records for coding accuracy and medical record documentation as it impacts the accuracy of ICD-10-CM, ICD-10-PCS codes driving the MS-DRG assignment and ICD-10 CM and CPT-4/HCPCS codes driving the APC assignment. This position will be able to identify Physician query opportunities, assess the accuracy of POA, discharge disposition and modifier assignments. Performs data collection for quality and statistical purposes and reports the finding to the Client and to Omega management. Must have the ability to independently perform client presentations as needed and represent the HIM QA Compliance team internally and/or externally.

Requirements

• Associate’s Degree or equivalent training acquired through on-the-job experience.
• At least three years of HIM experience within an Auditing capacity.
• Ability to prioritize and multi-task in a multifaceted environment.
• Demonstrate strong organizational skills and be detail oriented.
• Demonstrate ability to self-motivate, set goals, and meet deadlines.
• Demonstrate leadership, mentoring, and interpersonal skills.
• Demonstrate excellent presentation, verbal, and written communication skills.
• Ability to develop and maintain relationships with key business partners by building personal credibility and trust.
• Maintains courteous and professional working relationships with employees at all levels of the organization.
• Demonstrate excellent analytical, critical thinking and problem-solving skills.
• Ability to identify deficiencies and take corrective action.
• Proficient personal computer skills

Nice To Haves

• CCS, CPC, CCS-P, COC, CIC, RHIA or RHIT

Responsibilities

• Review inpatient and outpatient medical records for accuracy of coding and data quality.
• Independently completed reports for submission to the Client.
• Complete Quality Review reports timely and submits to Omega management (subsequently to Client) for review.
• May occasionally be selected to work with the Omega Compliance Team to develop and provide coder/coding training and education sessions, group, or one-on-one sessions, as needed, based on results of the Coding Quality Reviews.
• Utilize all available official references to perform reviews: to include but not limited to International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM), the Current Procedural Terminology (CPT-4) Official Coding Guidelines, Coding Clinic, CPT Assistant, CMS guidelines, etc.
• Communicate effectively with supporting staff and Omega point-of-contact(s). Provides information regarding work progress, actions, and issues in a timely and effective manner.
• Manage assigned projects including identifying scope of project, assigning audit staff, identifying and resolving issues with project timelines, parameters and other areas, monitoring and maintaining quality.
• Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance.
• Productivity management, PTO, QA and reviews/corrective action plans.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree