Remote DRG & Medical Coding Auditor

Southcarolinablues; Northern (KY); Hybrid; USD 70,000 - 110,000; Full time

Benefits offered by this job

Subsidized health plans

401k retirement savings

Life Insurance

Paid Time Off

Education Assistance

Job summary

BlueCross BlueShield of South Carolina seeks a Quality Medical Auditor to perform validation reviews of DRG, APC, and Never Events across lines of business. Remote position with standard hours 8:00am–5:00pm, Monday–Friday.

The role requires 3 years of medical records management with coding/validation review, strong HIPAA knowledge, and excellent communication. RHIA/RHIT/CPC/CIC/CPMA or active RN licensure in the US is required. Benefits include health plans, 401k, life insurance, PTO, and more.

Qualifications

• 3 years medical record management to include coding and validation review experience.
• Strong knowledge of medical records and coding.
• Excellent written and verbal communication, organizational and analytical skills.

Responsibilities

• Determine methodology to identify cases for validation review and coordinate rate adjustments.
• Create monthly/quarterly reports on records review, outcomes, trends, and savings.
• Manage records retrieval, HIPAA compliance, and document management.

Skills

Medical records management

Coding validation

HIPAA compliance

Analytical thinking

Contract evaluation

Education

Associate degree

Job description

BlueCross BlueShield of South Carolina seeks a Quality Medical Auditor to perform validation reviews of DRG, APC, and Never Events across lines of business. Remote position with standard hours 8:00am–5:00pm, Monday–Friday.

The role requires 3 years of medical records management with coding/validation review, strong HIPAA knowledge, and excellent communication. RHIA/RHIT/CPC/CIC/CPMA or active RN licensure in the US is required. Benefits include health plans, 401k, life insurance, PTO, and more.