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Quality Medical Auditor

Job

Spectraforce

Columbia, SC (In Person)

Full-Time

Posted 1 week ago (Updated 4 days ago) • Actively hiring

Expires 7/18/2026

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Job Description

Role Name:
Quality Medical Auditor Location:
Columbia, SC 29223
Work Environment:
Remote (Preferred Onsite)
Schedule:
Mon - Fri, 8AM-4:30PM Contract length: 4 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.