More jobs:
Quality Medical Auditor
Job in
Columbia, Lexington County, South Carolina, 29228, USA
Listed on 2026-07-19
Listing for:
Spectraforce Technologies
Contract
position Listed on 2026-07-19
Job specializations:
-
Healthcare
Medical Records, Medical Billing and Coding, Healthcare Compliance, Healthcare Administration
Job Description & How to Apply Below
Role Name:
Quality Medical Auditor
Location:Columbia, SC 29223
Work Environment:Remote (Preferred Onsite)
Schedule:Mon - Fri, 8AM-4PM
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.
Work Experience:
3 years medical record management to include coding and validation review experience.
License/Certification required:RHIT, RHIA, CIC, CPMA, or CPC.
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