South Carolina Licensed Medical Auditor
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Job Summary
To support healthcare operations, the full-time South Carolina Licensed Medical Auditor will perform validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events, while working remotely and coordinating rate adjustments with claims areas.
Key responsibilities
- Conducts validation reviews and coordinates rate adjustments with appropriate claims areas
- Creates monthly and quarterly reports outlining trends and outcomes related to records review
- Manages records retrieval, HIPAA compliance, and serves as an expert resource for medical records and coding issues
Required qualifications
- Associate's degree in a job-related field or equivalent work experience (2 years)
- 3 years of medical record management experience, 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 practices
- Working knowledge of contract evaluations and claims processing
Complete Job Description
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