Auditor, Quality Medical

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.