External Auditor In/Outpatient
About The Position
Under general supervision of the client, the External Auditor In/Outpatient reviews inpatient, outpatient, and professional services medical records for coding accuracy and documentation quality. The role assesses how documentation affects ICD-10-CM, ICD-10-PCS, MS-DRG, APC, and CPT-4/HCPCS coding and assignments. The auditor identifies opportunities for physician queries, writes compliant queries, and evaluates present-on-admission indicators, discharge disposition, and modifier assignments. The position also collects data for quality and statistical purposes and reports findings to Omega’s clients. The role maintains productivity according to client and Omega requirements, completes quality review reports promptly, and uses available official coding references. Duties must comply with company policies and procedures, including those concerning HIPAA and compliance. This is a full-time position in a remote home office environment, generally scheduled Monday through Friday, 8:00 a.m. to 5:00 p.m. Occasional long hours and weekend work may be required; travel is minimal, up to 5%.
Requirements
- Associate’s degree or equivalent training acquired through on-the-job experience.
- At least two years of HIM experience; auditing experience is preferred.
- At least one year of auditing experience.
- Successful completion of an AHIMA-approved Coding Certificate Program.
- Ability to prioritize and multitask in a multifaceted environment.
- Strong organizational skills and attention to detail.
- Ability to self-motivate, set goals, and meet deadlines.
- Leadership, mentoring, and interpersonal skills.
- Excellent presentation, verbal, and written communication skills.
- Ability to build credibility and trust and maintain relationships with key business partners.
- Ability to maintain courteous and professional working relationships with employees at all levels.
- 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, CPC-P, CPC-H, RHIA, or RHIT credential.
Responsibilities
- Review inpatient, outpatient, and physician services medical records for coding accuracy and data quality.
- For inpatient and observation cases, review assigned ICD-10-CM and ICD-10-PCS diagnosis and procedure codes, discharge disposition, present-on-admission indicators, and APR, SOI, and ROM assignments for inpatient cases.
- For outpatient cases, including emergency room, same-day surgery, and ancillary cases, review assigned ICD-10-CM and ICD-10-PCS diagnosis and procedure codes, CPT codes, modifier use and assignment, and APC assignment.
- For professional services, review assigned ICD-10-CM diagnosis codes, CPT codes, and E&M leveling codes.
- Identify physician query opportunities and write compliant queries.
- Maintain auditing productivity based on requirements agreed upon by the client and Omega.
- Complete quality review reports promptly and submit them to the client for review.
- Use available official references to perform reviews, including coding guidelines and relevant CMS guidance.
- Perform duties in compliance with company policies and procedures, including those related to HIPAA and compliance.
- Collect quality and statistical data and report findings to Omega’s clients.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
