Quality Medical Auditor

## Quality Medical Auditor-3

Apply:
Remote:
W@H Richland County, SC:
Full time:
Posted Today:
End Date:
October 10, 2026 (2 days left to apply):
R1052658#
** Summary
* * Performs validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events (serious, preventable medical errors) 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.#

** Description
* * Why should you join the Blue Cross Blue Shield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts.

We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!  
** Position

Purpose:

** Performs validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events (serious, preventable medical errors) 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.
*
* Location:

** This is a full-time remote position, with the regular work hours of 8:00am - 5:00pm, Monday through Friday.  
** What You’ll Do**:
* 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.  
** To Qualify For This Position, You'll Need The Following:**
* ** Required

Education:

** Associate's in a job related field
* ** Degree Equivalency:
** 2 years job related work experience.
* ** Required

Work Experience:

** 3 years medical record management to include coding and validation review experience.
* *
* Skills and Abilities:

** 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.
* ** Required Licenses and Certificates:
** Registered health information administrator (RHIA) OR Registered health information technician (RHIT) OR Certified Professional Coder (CPC) OR Certified Inpatient Coder (CIC) OR Certified Professional Medical Auditor (CPMA) OR, active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).  
** Our Comprehensive Benefits Package Includes The Following**:

We offer our employees great benefits and rewards. You will be…