Job Description

Objective

Under general supervision of client, Omega’s External Auditor Physician will perform reviews of inpatient and outpatient or Professional Services medical records for coding accuracy and medical record documentation as it impacts the accuracy of ICD-10-CM, ICD-10-PCS codes driving MS-DRG assignment and ICD-10-CM and CPT-4/HCPCS codes driving the APC assignment.The External Auditor Physician must be able to identify Physician query opportunities, write compliant queries, assess the accuracy of POA, discharge disposition and modifier assignments. External Auditor Physician performs data collection for quality and statistical purposes and reports the findings to Omega’s clients.

EssentialJob Functions

• Reviewinpatient,outpatient,orphysicianservicesmedicalrecordsforaccuracyofcodinganddataquality. Elements to be included in reviews can include:

  Inpatient/ObservationCases

  • AlldiagnosisandprocedureassignedICD-10-CMandICD-10PCS codes

  • Dischargedisposition assigned

  • AssignedPresentonAdmission(POA) indicators

  • APR,SOI,andROMassignmentforinpatientcases Outpatient Cases (ER, SDS, Ancillary)

  • AlldiagnosisandprocedureassignedICD-10-CMandICD-10PCS codes

  • AllCPTassigned codes

  • Modifieruseand assignment

  • APCassignment Professional Services

  • AlldiagnosiscodesassignedICD-10 CM

  • AllCPT codes

  • AllE&MLeveling codes

• MaintainauditingproductivitybasedonClientandOmegaagreedupon requirements

• CompleteQualityReviewreportstimelyandsubmitstoClientfor review.

• Utilize all available official references to perform reviews: to include but not limited to International ClassificationofDiseases,9 thEdition,ClinicalModification(ICD-9-CM),theCurrentProceduralTerminology (CPT-4) Official Coding Guidelines, Coding Clinic, CPT Assistant, CMS guidelines, etc.

• Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance.

KeySuccess Indicators/Attributes

• Abilitytoprioritizeandmulti-taskinamultifaceted environment.

• Demonstratestrongorganizationalskillsandbedetail oriented.
• Demonstrateabilitytoself-motivate,setgoals,andmeet deadlines.
• Demonstrateleadership,mentoring,andinterpersonal skills.

Demonstrateexcellentpresentation,verbal,andwrittencommunication skills.

• Abilitytodevelopandmaintainrelationshipswithkeybusinesspartnersbybuildingpersonalcredibilityand trust.

• Maintainscourteousandprofessionalworkingrelationshipswithemployeesatalllevelsofthe organization.

• Demonstrateexcellentanalytical,criticalthinkingandproblem-solving skills.
• Abilitytoidentifydeficienciesandtakecorrective action.
• Proficientpersonalcomputer skills

Supervisory Responsibility

No

WorkEnvironment

This job operates in a remote home office environment. This role routinely uses standard office equipment such as computers and phones

PhysicalDemands

Thephysicaldemandsdescribedherearerepresentativeofthosethatmustbemetbyanemployeeto successfully perform the essential functions of this job.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger,handle,orfeelobjects,tools,orcontrols;reachwithhandsandarms;climbstairs;balance;stoop,kneel, crouchorcrawl;andtalkorhear.Theemployeemustoccasionallyliftormoveupto25pounds.Specificvision abilities required by the job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus.

PositionType/ExpectedHoursof Work

This is a full-time position.Days and hours of work are generally Monday through Friday, 8:00 a.m. to 5 p.m. This position occasionally requires long hours and weekend work.

Travel

Minimumtravelrequired;upto 5%

RequiredEducationandExperience

• Associate’sDegreeorequivalenttrainingacquiredthroughon-the-job experience.

• Musthaveatleasttwoyearsof HIMexperience,preferablyasan Auditor.

• Atleastoneyearofauditing experience.

• MinimumofsuccessfulcompletionofanAHIMAapprovedCodingCertificate Program.

Preferred Education and Experience

None.

Additional Eligibility Qualifications

CCS, CPC, CPC-P, CPC-H, RHIA or RHIT

Security Access Requirements

In addition to the specific security access required by the employee’s client engagement, the employee will have access to the Omega systems set forth in the “Standard Field Employee” profile.

Microsoft Office

ADP

Oracle

Reveiwmate

E1- All Field Employees

Standard Employee

Standard

Coder and Client Access based on client needs. Determined by manager and granted by Audit Implementation Manager

Equal Employment Opportunity:

Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcare also prohibits harassment of applicants or employees based on any of these protected categories.

Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at employeerelationsus@omegahms.com

OtherDuties
Pleasenotethisjobisnotdesignedtocoverorcontainacomprehensivelistingofactivities, dutiesorresponsibilitiesthatarerequiredoftheemployeeforthisjob.Duties,responsibilities,and activitiesmaychangeatanytimewithorwithoutnotice.Employeemayperformotherdutiesasassigned.

Founded in 2003, Omega Healthcare Management Services® (Omega Healthcare) empowers healthcare to thrive via intelligent solutions that optimize revenue cycle operations, administrative workflows, care coordination, and clinical research on a global scale. The company works with providers, payers, life science companies, medical device manufacturers, health technology firms, researchers, and industry partners to amplify teams with robust technology, specialty expertise, and operational support. Omega Healthcare serves more than 350 healthcare organizations with 35,000 skilled workers in the United States, India, Colombia, and the Philippines. For more information, visit www.omegahms.com

We offer a comprehensive benefits package that may include health, dental, and vision coverage, voluntary insurance options, a 401(k) plan with employer match, professional development opportunities, paid time off, and holiday pay. Eligible employees may also have the opportunity to participate in bonus programs, commissions, or other variable incentive plans. Benefits and incentive eligibility may vary based on position, location, and tenure.

AAP/EEO Statement

Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcare also prohibits harassment of applicants or employees based on any of these protected categories.

Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at employeerelationsus@omegahms.com