Role Name: Quality Medical Auditor Location: Columbia, SC 29223 Work Environment: Remote Schedule: Mon - Fri, 8AM-4:30PM or 8:30AM -5:30PM 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. Required Education: Associate Degree - Nursing or Health Information Management or Graduate of an Accredited School of Nursing License/Certification required: RHIT, RHIA, CIC, CPMA, or CPC.
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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.The pay rate for this position is $36.00/hr.
