External Auditor Physician

Omega Healthcare Management Services•Boca Raton, FL

3d•Remote

About The Position

Under general supervision of the client, the External Auditor Physician reviews inpatient, outpatient, and professional services medical records for coding accuracy and documentation quality. The role evaluates how documentation affects ICD-10-CM, ICD-10-PCS, CPT-4, and HCPCS coding and resulting MS-DRG and APC assignments. The auditor identifies physician query opportunities, writes compliant queries, and assesses the accuracy of present-on-admission indicators, discharge disposition, and modifier assignments. The role also collects data for quality and statistical purposes and reports findings to Omega’s clients. The position is full-time and generally works Monday through Friday, 8:00 a.m. to 5:00 p.m. Occasional long hours and weekend work may be required. It operates in a remote home-office environment, uses standard office equipment such as computers and phones, and requires minimal travel of up to 5%.

Requirements

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.
Associate’s degree or equivalent training acquired through on-the-job experience.
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 with key business partners and maintain courteous, professional working relationships.
Excellent analytical, critical-thinking, and problem-solving skills, including the 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.
Review inpatient and observation cases for assigned ICD-10-CM and ICD-10-PCS diagnosis and procedure codes, discharge disposition, present-on-admission indicators, and inpatient APR, SOI, and ROM assignments.
Review outpatient cases, including emergency room, same-day surgery, and ancillary cases, for assigned ICD-10-CM and ICD-10-PCS diagnosis and procedure codes, CPT codes, modifier use and assignment, and APC assignment.
Review professional-services records for assigned ICD-10-CM diagnosis codes, CPT codes, and evaluation and management leveling codes.
Identify physician query opportunities and write compliant queries.
Maintain audit productivity in accordance with requirements agreed upon by the client and Omega.
Complete quality review reports in a timely manner and submit them to the client for review.
Use available official references to conduct reviews, including applicable ICD coding references, CPT-4 Official Coding Guidelines, Coding Clinic, CPT Assistant, and CMS guidelines.
Collect data for quality and statistical purposes and report findings to Omega’s clients.
Perform duties in compliance with company policies and procedures, including those relating to HIPAA and compliance.
Prioritize and manage multiple tasks, meet deadlines, and take corrective action when deficiencies are identified.
Build and maintain relationships with business partners and professional working relationships with employees throughout the organization.
Perform other duties as assigned.