Medical Review Auditor

Medical Review Auditor Job at a

Glance Title:

Medical Review Auditor Location:

South Carolina or bordering North Carolina; potential for remote work, but onsite preferred

Contract:

W2 only,

Pay:

$36.00 /hour + optional medical, dental, vision, 401(k) match Overview Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events in a healthcare setting. Coordinates rate adjustments with claims areas and provides reports on trends, outcomes, and savings impacting medical costs and contracting rates. Serves as a resource for coding issues and manages HIPAA and legal records requests. Key Responsibilities 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. Manages records retrieval, release, HIPAA compliance, and all aspects of document management. Serves as expert resource on methodology and procedures for medical records and coding issues. Required Skills Associate Degree in Nursing or Health Information Management or Graduate of an Accredited School of Nursing 3 years medical record management experience including coding and validation review Knowledge of DRG reviews and audits Ability to coordinate rate adjustments with claims areas Experience creating detailed reports on trends and outcomes Required Education Associate Degree - Nursing or Health Information Management or Graduate of an Accredited School of Nursing Preferred Skills RHIT, RHIA, CIC, CPMA, or CPC certification Experience with HIPAA compliance and legal records requests Ability to work independently and manage multiple priorities Why Should I Apply? This position offers an opportunity to work in a critical healthcare review role with potential for remote work and career growth. Join a team focused on improving healthcare outcomes and cost management.

About CEI:

As a trusted technology partner, CEI delivers solutions that help our customers transform their business and achieve meaningful results. From strategy and custom application development through application management - our technology and digital experience services are tailored to meet each unique need of our customers. Our staffing solutions bring specialized skills to complement our customers' workforce and project requirements. #ZR #INDGEN