Auditing, Claims Processing, Code Reviews, Consulting, Develop Methodologies, Diagnosis-Related Group (DRG), HIPAA (Health Insurance Portability and Accountability Act), Health Information Management, Healthcare, Healthcare Quality, Legal, Maintain Compliance, Medical Records, Nursing, Nursing Credentials, Problem Solving Skills, Records Management, Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Trend Analysis, Work From Home
Job Category: Medical / Healthcare
Contract Type: Contract to Hire
Client Location: Columbia, South Carolina 29223
Work Arrangement: Remote work (equipment provided by Client)
Join our team in Columbia, SC, a vibrant city known for its rich history and southern charm, as we expand our operations to meet the growing demand for quality medical auditing. This role offers an exciting opportunity to make a significant impact in the healthcare sector by ensuring accuracy and compliance in medical records. Duties:
- 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.
- Provide monthly and quarterly reports outlining trends that directly impact medical costs and contracting rates.
- Serve as a resource in resolving coding issues and manage records retrieval, release, and HIPAA compliance.
- Coordinate HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department.
Required Training: An active license of, one of the following:
CPC (Certified Professional Coder) OR
CIC (Certified Inpatient Coder) OR
CPMA (Certified Professional Medical Auditor) OR
RHIT (Registered Health Information Technician) OR
RHIA (Registered Health Information Administrator)
Skills and Abilities:
- Develop methodologies
- Follow processes
- Respond to inquiries
- Write for impact
Required Education: Associate Degree in Nursing or Health Information Management, OR Graduate of an Accredited School of Nursing
Required Work Experience: 3 years of medical record management experience, including coding and validation review experience Interview Process: MS Teams
Due to an increased volume of DRG reviews, we are expanding our team. A typical day involves conducting DRG reviews and audits, collaborating with the existing team of Medical Review Auditors, and ensuring precise and compliant medical record management.
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Talent Software Services, Inc.