Quality Review Auditor

US Tech Solutions; Columbia (SC); On-site; USD 40,914 - 58,272; Full time

Job summary

A leading staffing firm in South Carolina is seeking a Certified Coding Specialist or RN for a 3+ month contract role. Responsibilities include conducting validation reviews of Diagnosis Related Groups (DRG), managing HIPAA compliance, and generating monthly reports. Candidates must have at least 3 years of medical record management experience, including coding. This role offers a competitive rate of $36.00/hr. Join a diverse team committed to making a difference in healthcare.

Qualifications

• 3 years medical record management experience, including coding and validation review.
• Certified Coding Specialist or RN required.

Responsibilities

• Determines methodology to identify cases for validation review.
• Conducts validation reviews and coordinates rate adjustments.
• Creates reports on records review, outcomes, trends, and savings.
• Manages records retrieval and HIPAA compliance.
• Serves as an expert resource on medical records and coding issues.

Skills

Develops methodologies

Follows processes

Responds to inquiries

Writes for impact

Education

Associate Degree - Nursing or Health Information Management

Job description

Overview

Base pay range: $36.00/hr - $36.00/hr

Duration: 3+ Months Contract (Possible temp to hire)

Job Description:

• MONDAY-FRIDAY, 8AM-4:30PM.
• Certified Coding Specialist or RN.
• A typical day includes DRG reviews and audits; performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events for all lines of business. Coordinates rate adjustments with claims areas.
• Provides monthly and quarterly reports outlining trends.
• Serves as a resource in resolving coding issues. Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department.

Responsibilities:

• Determines methodology to identify cases for validation review.
• Conducts validation reviews and coordinates rate adjustments with the appropriate claims area.
• Creates monthly/quarterly reports presenting information on records review, outcomes, trends, and savings that impact medical costs and contracting rates.
• Manages records retrieval, release, HIPAA compliance, and all aspects of document management.
• Serves as an expert resource on methodology and procedures for medical records and coding issues.

Experience:

• 3 years medical record management to include coding and validation review experience.

Skills:

• Develops methodologies
• Follows processes
• Responds to inquiries
• Writes for impact

Education:

Associate Degree - Nursing or Health Information Management or Graduate of an Accredited School of Nursing Required Work Experience.

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Recruiter Details:

Name: Shailesh

Internal Id: 25-54912