Auditor/Educator In/Outpatient

Omega Healthcare Solutions · United States

Essential Job Functions: Initial Audit and Education: - For assigned coding staff, conduct initial quality audits as they go through onboarding process for new project / client assignment, and provide education to staff based on initial quality audit findings. Review medical records for accuracy of coding and data quality. Elements included in reviews may include: CDI audit reviews - Auditing: - Reviewing medical records, including clinical notes, lab results, and other diagnostic information, to ensure documentation accurately reflects diagnoses, severity of illness, and risk of mortality. - Compliance: - Ensuring documentation complies with regulatory requirements, coding guidelines, and payer rules. - Identifying Gaps: - Identifying missed documentation opportunities, inconsistencies, and areas where documentation can be more specific or clarified. - Query Review: - Evaluating the appropriateness of queries issued to physicians, ensuring they are supported by clinical evidence and aligned with coding guidelines. - Data Analysis: - Analyzing data related to CDI performance, identifying trends, and reporting findings to leadership. - Education and Training: - Providing education and training to CDI staff, physicians, and other healthcare professionals on documentation best practices, coding guidelines, and regulatory requirements. - Skills and Qualifications: - Clinical Knowledge: - Strong understanding of disease processes, clinical conditions, and medical terminology. - Coding Knowledge: - Familiarity with ICD-10-CM/PCS, CPT, and other relevant coding systems. - CDI Experience: - Experience in clinical documentation integrity, including chart review and query writing. - Analytical Skills: - Ability to analyze data, identify trends, and make recommendations for improvement. - Communication Skills: - Excellent written and verbal communication skills to effectively communicate with various healthcare professionals. • Inpatient /Observation Cases

• All diagnosis and procedure assigned ICD-10-CM and ICD-10 PCS codes
• Discharge disposition assigned
• Assigned Present on Admission (POA) indicators
• APR-DRG, MS-DRG, SOI, and ROM assignment for inpatient cases
• Appropriateness of queries created

• All diagnosis and procedure assigned ICD-10-CM and ICD-10 PCS codes
• All CPT assigned codes
• Modifier use and assignment
• APC assignment