Certified Medical Auditor (SC)

Job Summary

A company is looking for a Quality Medical Auditor.

Key Responsibilities

• Conducts validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events
• Coordinates rate adjustments with claims areas and creates monthly/quarterly reports on trends and outcomes
• Manages records retrieval, HIPAA compliance, and serves as a resource for coding issues

Required Qualifications

• Associates degree in a job-related field or equivalent 2 years of job-related work experience
• 3 years of experience in medical record management, including coding and validation review
• Registered health information administrator (RHIA) or technician (RHIT), Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Professional Medical Auditor (CPMA), or active RN licensure
• Extensive knowledge of medical records and coding
• Working knowledge of contract evaluations and claims processing practices