Auditor, Quality Medical

Auditor, Quality Medical

Job Summary: Talent Software Services is in search of an Auditor, Quality Medical for a contract position in Columbia, SC. The opportunity will be for three months with a strong chance for a long-term extension.

Position Summary: Join our dynamic team in Columbia, SC, a vibrant city known for its rich history and welcoming community. We are seeking a dedicated professional to perform critical validation reviews and manage records for our healthcare services.

Primary Responsibilities/Accountabilities:

• Perform validation reviews of Diagnosis-Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events for all lines of business.
• Coordinate rate adjustments with claims areas and provide monthly and quarterly reports outlining trends.
• Serve as a resource in resolving coding issues and coordinate HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department.
• Determine methodology to identify cases for validation review and conduct validation reviews/coordinate rate adjustments with the appropriate claims area.
• Create monthly/quarterly reports to present to each line of business, providing information on records review, outcomes, trends, and savings impacting medical costs and contracting rates.
• Manage records retrieval, release, HIPAA compliance, and all aspects of document management.
• Serve as an expert resource on methodology and procedures for medical records and coding issues.
  
  

Qualifications:

• Required Training: Registered Records Administrator or Technician, 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), OR Certified Coding Specialist.
• Skills and Abilities: Develops methodologies, follows processes, responds to inquiries, and writes for impact.
  
  

If this job is a match for your background, we would be honoured to receive your application!

Providing consulting opportunities to TALENTed people since 1987, we offer a host of opportunities, including contract, contract to hire, and permanent placement. Let's talk