Compliance & Quality Audit Manager

Summary/Objective
This position 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 the MS-DRG assignment and ICD-10 CM and CPT-4/HCPCS codes driving the APC assignment. This position will be able to identify Physician query opportunities assess the accuracy of POA discharge disposition and modifier assignments. Performs data collection for quality and statistical purposes and reports the finding to the Client and to Omega management. Must have the ability to independently perform client presentations as needed and represent the HIM QA Compliance team internally and/or externally.

Essential Job Functions

• Review inpatient and outpatient medical records for accuracy of coding and data completed reports for submission to the Client. Elements to be included in reviews can include:

  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 SOI and ROM assignment for inpatient cases

Outpatient Cases (ER SDS Ancillary)

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

Professional Services

• All diagnosis codes
  • All CPT codes
  • All E&M Leveling codes
• Maintain auditing productivity based on Client and Omega agreed-upon requirements
• Complete Quality Review reports timely and submits to Omega management (subsequently to Client) for review.
• May occasionally be selected to 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.
• Utilize all available official references to perform reviews: to include but not limited to International Classification of Diseases 10^th Edition Clinical Modification (ICD-10-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.
• Manage assigned projects including identifying scope of project assigning audit staff identifying and resolving issues with project timelines parameters and other areas monitoring and maintaining quality.
• Perform duties in compliance with Companys policies and procedures including but not limited to those related toHIPAA and compliance.

Key Success Indicators/Attributes

• Ability to prioritize and multi-task in a multifaceted environment.

• Demonstrate strong organizational skills and be detail oriented.

• Demonstrate ability to self-motivate set goals and meet deadlines.

• Demonstrate leadership mentoring and interpersonal skills.

• Demonstrate excellent presentation verbal and written communication skills.

• Ability to develop and maintain relationships with key business partners by building personal credibility and trust.

• Maintains courteous and professional working relationships with employees at all levels of the organization.

• Demonstrate excellent analytical critical thinking and problem-solving skills.

• Ability to identify deficiencies and take corrective action.

• Proficient personal computer skills

Supervisory Responsibility

• Supervisory responsibilities for assigned auditors including but not limited to: Productivity managementPTO QA and reviews/corrective action plans.

Work Environment

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

Physical Demands

The physical demands described here are representative of those that must be met by an employee to 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 or feel objects tools or controls; reach with hands and arms; climb stairs; balance; stoop kneel crouch or crawl; and talk or hear. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision distance vision peripheral vision depth perception and the ability to adjust focus.

Position Type/Expected Hours of 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

Minimum travel required; up to 5%

Required Education and Experience

• Associates Degree or equivalent training acquired through on-the-job experience.

• At least three years of HIM experience within an Auditing capacity.

Preferred Education and Experience

None

Additional Eligibility Qualifications

CCS CPC CCS-P COC CIC RHIA or RHIT

Security Access Requirements

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

• Microsoft Office: E1 Level

• ADP: Standard Employee Access Level

• Oracle: Standard Access

• ReviewMate: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 Healthcarealso 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.

Other Duties