Quality Medical Auditor

This is a fully remote position, open to applicants in South Carolina.

📋 Description

• Identify the methodology for selecting cases for validation review.

• Perform validation reviews and collaborate with claims departments for rate modifications.

• Generate monthly and quarterly reports detailing records review, outcomes, trends, and savings related to medical expenses and contracting rates.

• Oversee records retrieval, release procedures, HIPAA compliance, and document management.

• Act as an expert resource on medical records and coding methodologies and processes.

• Coordinate HIPAA and legal records requests for Healthcare Services and the Legal Department.

• Assist in resolving coding-related issues.

⛳️ Requirements

• Associate's degree in a relevant field.

• 2 years of relevant work experience may be considered equivalent to a degree.

• 3 years of experience in medical record management, including coding and validation reviews.

• Strong verbal and written communication, organizational, customer service, and analytical or critical thinking skills.

• Sound judgment.

• Capability to manage confidential or sensitive information with care.

• Comprehensive understanding of medical records and coding.

• Familiarity with contract evaluations, claims processing, and adjudication practices.

• One of the following: RHIA, RHIT, CPC, CIC, 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.

• Inpatient experience is preferred.

🏝️ Benefits

• Subsidized health plans, including dental and vision coverage.

• 401k retirement savings plan with company matching.

• Life Insurance.

• Paid Time Off (PTO).

• On-site cafeterias and fitness centers in major locations.

• Education Assistance.

• Service Recognition.

• National discounts for movies, theaters, zoos, theme parks, and more.