Quality Medical Auditor
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Job Description
Medical auditor validating DRG/APC coding, medical records, and claims rates. Producing trend reports and coordinating HIPAA records for South Carolina’s largest insurer.
Responsibilities:
- Determine methodology to identify cases for validation review
- Conduct validation reviews and coordinate rate adjustments with the appropriate claims area
- Create monthly and quarterly reports for each line of business covering records reviewed, outcomes, trends, and savings impacting medical costs and contracting rates
- Manage records retrieval, release, HIPAA compliance, and document management
- Serve as an expert resource on medical records and coding methodologies and procedures
- Coordinate HIPAA and legal records requests for Healthcare Services and the Legal Department
- Resolve coding issues and support all lines of business
Requirements:
- Associate's in a job related field
- 2 years job related work experience may satisfy the degree equivalency
- 3 years medical record management experience including coding and validation review experience
- Excellent verbal and written communication, organizational, customer service, and analytical or critical thinking skills
- Good judgment
- Ability to handle confidential or sensitive information with discretion
- Extensive medical records and coding knowledge
- Working knowledge of contract evaluations, claims processing and adjudication practices
- One of: Registered health information administrator (RHIA), Registered health information technician (RHIT), Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Professional Medical Auditor (CPMA), active unrestricted RN licensure from the United States and state of hire, or active compact multistate unrestricted RN license under the Nurse Licensure Compact (NLC)
- Regular work hours of 8:00am–5:00pm, Monday through Friday
Benefits:
- Subsidized health plans, dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
- Diverse and inclusive workplace
- Reasonable accommodations for disabilities, pregnancy-related conditions, and sincerely held religious beliefs
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