Lead Compliance & Quality Audit

Omega Healthcare Solutions•Boca Raton, FL

2d•Remote

About The Position

Under limited supervision, Omega’s Lead Compliance and Quality Audit Manager performs audits of inpatient and outpatient 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. Lead Compliance and Quality Audit Manager must be able to identify Physician query opportunities, assess the accuracy of POA, discharge disposition and modifier assignments. Lead Compliance and Quality Audit Manager performs data collection for quality and statistical purposes and reports the finding the Client. The Lead Compliance and Quality Audit Manager is the first line of support for the HIM QA Managers, assists in coaching and developing staff members as necessary and completes special projects as assigned.

Requirements

AHIMA Approved ICD-10 CM/PCS Trainer
Minimum of successful completion of an AHIMA-approved Coding Certificate Program;
Associate’s degree or equivalent training acquired through five years of progressive on-the-job experience.
Must have at least five years of HIM experience, preferably as an Auditor.
Must have CCS, CPC, CPC-P, CPC-H, RHIA or RHIT
Extensive knowledge of ICD-10-CM, ICD -10 PCS and CPT-4 coding and MS-DRG and APR-DRG assignment.
Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing in addition to those that are state-specific.
Knowledge of documentation requirements to support coding and POA assignment is required.
Extensive knowledge of medical terminology, anatomy, and physiology
Demonstrate ability to self-motivate, set goals, and meet deadlines.
Demonstrate professional demeanor and strong interpersonal skills.
Demonstrate excellent presentation, verbal, and written communication skills.
Demonstrate excellent analytical, critical thinking and problem-solving skills.
Skill in operating a personal computer and utilizing a variety of software applications.
Knowledge of coding convention and rules established by the American Medical Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS), for assignment of diagnostic and surgical procedural codes.
Knowledge of JCAHO, coding compliance and HIPAA-HITECH standards affecting medical records and the impact on reimbursement and accreditation.

Responsibilities

Review inpatient and outpatient medical records for accuracy of coding and data quality. Elements to be included in reviews can include:
Maintain auditing productivity based on Client and Omega agreed upon requirements.
Complete Quality Review reports timely and submits Omega (subsequently to Client) for review.
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.
Provide support in the absence of the Manager, CQA Services, demonstrating aptitude to temporarily perform all duties of the Manager, CQA Services.
Provide support for special assignments which may include but are not limited to phone assessments, CodeONe, strategic initiatives and cross functional teams.
Utilize all available official references to perform reviews: to include but not limited to International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-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.
Must be skilled in Microsoft Excel.
Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance.