Quality Medical Auditor

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

📋 Description

• Establish methodologies to identify cases requiring validation review.

• Perform validation reviews and coordinate rate adjustments with the relevant claims departments.

• Generate monthly and quarterly reports for each line of business, detailing records reviewed, outcomes, trends, and savings that affect medical costs and contracting rates.

• Oversee the retrieval, release, HIPAA compliance, and management of documents.

• Act as a subject matter expert on medical records and coding methodologies and procedures.

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

• Address coding issues and provide support across all lines of business.

⛳️ Requirements

• Associate's degree in a relevant field.

• Two years of relevant work experience may be considered equivalent to the degree requirement.

• Three years of experience in medical record management, including coding and validation review.

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

• Sound judgment.

• Ability to manage confidential or sensitive information with care.

• Extensive knowledge of medical records and coding.

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

• One of the following certifications: 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 working hours from 8:00 am to 5:00 pm, Monday through Friday.

🏝️ Benefits

• Subsidized health plans, along with dental and vision coverage.

• 401k retirement savings plan with company match.

• Life Insurance.

• Paid Time Off (PTO).

• On-site cafeterias and fitness centers available at major locations.

• Education Assistance.

• Service Recognition.

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

• A diverse and inclusive workplace environment.

• Reasonable accommodations for disabilities, pregnancy-related conditions, and sincerely held religious beliefs.