Internal Auditor – Profee

Essential Job Functions

Review physician services medical records for accuracy of coding and data quality. Elements to be
included in reviews can include:

Professional Services

All diagnosis assigned ICD-10 CM codes
All CPT codes
All CPT E&M level codes
Maintain auditing productivity based on Client and Omega agreed upon requirements.
Complete Quality Review reports timely and submits to coder, Omega management (subsequently to Client) for review.
Utilize all available official coding references to perform reviews, to include but not limited to International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM and ICD-10-PCS), the Current Procedural Terminology (CPT-4) Official Coding Guidelines, Coding Clinic, CPT Assistant, CMS guidelines, etc.
Utilize client specific coding policies and guidelines in conjunction with Official Guidelines to perform reviews.
Communicate effectively with supporting staff and Omega point-of-contact(s).
Provide 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.

Key Success Indicators/Attributes

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 coding conventions 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.
Knowledge of documentation requirements to support coding and POA assignment is required.
Extensive knowledge of medical terminology, anatomy, and physiology.
Ability to prioritize and multi-task in a multifaceted environment.
Demonstrate strong organizational skills and detail oriented.
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.
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 escalate.
Proficient personal computer skills and utilizing a variety of software applications.

Supervisory Responsibility

None

Required Education and Experience

Associate’s Degree or equivalent training acquired through on-the-job experience.
At least three years of HIM coding experience.
At least two years total audit experience with one year of current audit experience.
Minimum of successful completion of an AHIMA/AAPC approved Coding Certificate Program.
Must have intermediate level knowledge of Microsoft Office Suite
Intermediate to advance technical knowledge of HIM electronic medical systems and software tools, such as Epic, Cerner, Allscripts, Optum 360, BOX, ReviewMate, etc. Specific system experience will vary based on client’s needs.

Preferred Education and Experience

Five years of HIM experience as a compliance auditor.

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