External Auditor Physician

Omega Healthcare Solutions•Boca Raton, FL

1d•Remote

About The Position

Omega Healthcare Management Services is seeking an External Auditor Physician with a minimum of 3 years of experience auditing EM and procedures across multiple specialties, particularly in radiology, neuro, and ortho at a trauma 1 facility. Epic experience is required, and Codify experience is preferred. The role involves auditing professional fee coding, ensuring compliance with coding guidelines, and identifying areas for improvement in revenue cycle operations.

Requirements

Minimum of 3 years of experience auditing EM and procedures.
Experience auditing across multiple specialties, particularly radiology, neuro, and ortho.
Experience at a trauma 1 facility.
Epic experience required.
Advanced proficiency in CPT, HCPCS Level II, and ICD-10-CM coding guidelines.
Strong expertise in Evaluation & Management (E/M) coding.
Extensive experience auditing procedure-based coding.
In-depth knowledge of NCCI edits, MUEs, modifier usage, and bundling/unbundling rules.
Ability to evaluate and validate medical necessity and accurate code assignment.
Proven experience auditing professional fee coding across multiple specialties.
Strong knowledge of CMS guidelines, payer policies, and federal/state compliance requirements.
Familiarity with OIG Work Plan, audit risk areas, and regulatory updates.
Experience supporting internal and external audits, including payer audits and RAC reviews.
Experience conducting retrospective and concurrent coding audits.
Skilled in developing audit reports, scorecards, and executive summaries.
Strong understanding of clinical documentation requirements.
Ability to identify documentation gaps and provide actionable recommendations.
Working knowledge of medical terminology, anatomy, physiology, and disease processes across specialties.
Ability to clearly communicate audit findings, rationale, and coding guidelines to stakeholders.
Experience collaborating with providers, coding teams, CDI, and operational leadership.
Strong presentation skills for delivering education sessions and audit results.
Ability to mentor and guide coders to improve quality and compliance performance.

Nice To Haves

Codify experience preferred.

Responsibilities

Audit EM and procedures across multiple specialties, including radiology, neuro, and ortho.
Utilize Epic and Codify (preferred) systems for auditing.
Ensure advanced proficiency in CPT, HCPCS Level II, and ICD-10-CM coding guidelines.
Conduct audits for various E/M services (office, hospital, consults, ED, critical care).
Audit procedure-based coding across multiple specialties.
Evaluate and validate medical necessity and accurate code assignment.
Interpret specialty-specific documentation and apply appropriate coding rules.
Maintain strong knowledge of CMS guidelines, payer policies, and compliance requirements.
Identify coding trends, compliance risks, and revenue leakage.
Conduct retrospective and concurrent coding audits.
Calculate and report accuracy rates, error categorization, and financial impact.
Develop audit reports, scorecards, and executive summaries.
Create and deliver education and feedback to coders and providers.
Focus on continuous quality improvement and audit calibration processes.
Review clinical documentation to support E/M and procedural services.
Identify documentation gaps and provide actionable recommendations.
Communicate audit findings, rationale, and coding guidelines to stakeholders.
Collaborate with providers, coding teams, CDI, and operational leadership.
Deliver education sessions and present audit results.
Mentor and guide coders to improve quality and compliance performance.