External Auditor Physician

Summary/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.

Essential Job Functions

• Review inpatient, outpatient, or physician services medical records for accuracy of coding and data quality. 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 assigned ICD-10 CM

  • 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 Client for review.

• Utilize all available official references to perform reviews: to include but not limited to International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM), the Current Procedural Terminology (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.

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