Essential Job Functions
Pull medical record (H&P, op notes, anesthesia record, MAR, nursing notes,
implant logs, pathology, radiology) and itemized bill / UB-04 / 1500 detail
and reconcile line by line against billed charges.
Validate CPT / HCPCS / ICD-10-CM / revenue code / modifier / units / DOS
against documentation; flag overcharges, undercharges, missing charges, and
inappropriate bundling / unbundling.
Apply NCCI PTP, MUE, OCE, and LCD / NCD logic; document defensibility of each
line decision.
Defend billed charges against payor / payor-vendor audit findings (Equian /
Optum Payment Integrity / Cotiviti / Zelis / SCIO / others).
Build a structured rebuttal with citations (CMS NCCI manuals, AMA CPT
guidelines, payor policy, AHA Coding Clinic, contract language as
applicable).
Negotiate with audit vendors within delegated authority; escalate to Lead
when concession would exceed threshold.
Review patient billing disputes raised through customer service / Patient
Financial Services intake.
Reconcile disputed line items against medical record and applicable EOB;
produce a patient-readable explanation.
Escalate suspected billing errors for write-off / adjustment per client
policy.
Maintain a real-time individual case log (tracking status, turnaround time, $
impact, and outcomes) using standardized taxonomies to support portfolio
trend analysis.
Produce reproducible, structured audit reports using standard templates to
communicate scope, methodology, line-level results, and root causes to client
stakeholders and feed activity reports.
Navigate provider EHR platforms (e.g., Epic, Cerner, Meditech) and
specialized auditing software to abstract clinical documentation and support
defense workflows.
Operate under HIPAA, HITRUST, and OIG / RAC / MAC awareness; never share PHI
outside authorized channels.
Cooperate fully with internal QA on sample audits; respond to QA findings
with documented corrective action.
Key Success Indicators/Attributes
High comfort level reading dense clinical records (MAR, operative notes,
nursing logs) and cross-referencing against itemized bills to identify root
causes.
Confidence and technical writing skills to draft clear audit findings and
defend them during payor rebuttal cycles, with the objectivity to overturn
findings when evidence shifts.
Clear understanding of how line-item charge adjustments impact gross/net
revenue, DRG allowances, and patient billing integrity.
Consistently meets daily turnaround time (TAT) targets without compromising
audit accuracy.
Sustained concentration and analytical rigor required to execute multi-hour
reviews on complex inpatient, surgical, and high-dollar cases.
Confidentiality and PHI discipline.
Maintain courteous and professional working relationships with employees at
all levels of the organization.
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 [http://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 [employeerelationsus@omegahms.com].