Auditor, Quality Medical

About the Role

Talent Software Services is seeking an Auditor, Quality Medical for a three-month contract position in Columbia, SC, with a strong chance for a long-term extension. This role involves performing critical validation reviews and managing records for healthcare services in a vibrant city known for its rich history and welcoming community.

Responsibilities

• 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

• Develops methodologies and follows processes.
• Responds to inquiries and writes for impact.