Auditor, Quality Medical

Job Description

Role Name:

 Quality Medical Auditor

Location:

Columbia, SC 29223

Work Environment:

Remote (Preferred Onsite)

Schedule:

Mon - Fri, 8AM-4:30PM Contract length: 3 months assignment with possible conversion

Job Summary:

Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (inexcusable outcomes in a healthcare setting) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department Day to

Day:

75% Determines methodology to identify cases for validation review. Conducts validation reviews/coordinates rates adjustments with appropriate claims area. Creates monthly/quarterly reports to present to each line of business providing information on records review, outcomes, trends, and savings that directly impact medical costs and contracting rates. 15% Manages records retrieval, release, HIPAA compliance, and all aspects of document management. 10% Serves as expert resource on methodology and procedures for medical records and coding issues.

Required Work Experience:

3 years medical record management to include coding and validation review experience. License/Certification required: RHIT, RHIA, CIC, CPMA, or CPC. Applicant Notices & Disclaimers For information on benefits, equal opportunity employment, and location-specific applicant notices, click here At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position's starting pay is: $34.00/daily.