Auditor/Educator Inpatient

Summary/Objective 
Under the supervision of the Manager, Compliance and Quality Audit, Internal Auditor/Educator will perform reviews of inpatient 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/APR-DRG assignment.  The Auditor must also be able to identify coding trends, physician query opportunities, assess the accuracy of POA, discharge disposition and modifier assignments.  Auditor must utilize manual Excel templates to perform data collection for quality and statistical purposes for reporting and providing education to the Coder, Client and Omega management. Auditor must utilize PowerPoint to develop and deliver coder education based on identified trends and topics. 

 

Essential Job Functions 

• Review inpatient, medical records for accuracy of coding and data quality.  
• Develop coder education based on identified trends and topics.

Elements to be included in reviews can include: 

Inpatient Cases 

• All diagnosis and procedures assigned ICD-10-CM and ICD- 10 PCS codes 
• Validation of MS-DRG/APR-DRG 
• APR, SOI, and ROM assignment  
• Query opportunities 
• Discharge disposition assigned 
• Assigned Present on Admission (POA) indicators  
• Must be skilled in Microsoft Excel. 
• Must be skilled in Microsoft PowerPoint presentation development.

 

Key Success Indicators/Attributes 

• Extensive knowledge of ICD-10-CM, ICD -10 PCS 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 

 

Work Environment 

This job operates in a professional remote office environment.  This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. Auditor is responsible for assuring they have all the necessary equipment (including reliable high-speed internet) to perform the required job duties to meet Omega standards, such as a dual monitor. Office environment should be away from distractions and free from noise during working hours.  

 

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 Part-time position.  Days and hours of work are generally Monday through Friday, 8:00 a.m. to 5:00 p.m.  This position requires approximately one late weeknight every two weeks.  This position occasionall