Remote Medical Auditor: DRG/Code Validation Expert

ourhrconnect; South Carolina; Hybrid; USD 65.000 - 90.000; Vollzeit

Benefits dieser Stelle

Subsidized health plans, dental and視on

401k retirement savings with company 8

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Zusammenfassung

BlueCross BlueShield of South Carolina is seeking a Health Information Coder to perform validation reviews of DRG, APC, and Never Events, coordinating rate adjustments with the claims area and producing monthly/quarterly reports on trends and savings.

This full-time remote role requires strong medical records and coding knowledge, plus experience with HIPAA and contract evaluations. You will support multiple lines of business and contribute to cost containment and compliance.

Qualifikationen

• Associate's in a job related field.
• 2 years job related work experience.
• 3 years medical record management including coding and validation review.
• Excellent communication, organizational, customer service, and analytical skills.
• Licenses: RHIA, RHIT, CPC, CIC, CPMA or RN license in the US; or compact RN per NLC.

Aufgaben

• Determines methodology to identify cases for validation review.
• Coordinates rate adjustments with claims area and creates monthly/quarterly reports.
• Manages records retrieval, release, HIPAA compliance, and document management.
• Serves as expert resource on medical records and coding issues.

Kenntnisse

Verbal & written communication

Organizational skills

Customer service

Analytical thinking

Judgment

Discretion with confidential info

Medical records & coding knowledge

Contract evaluations

Claims processing

Adjudication practices

Ausbildung

Associate's degree in a related field

Jobbeschreibung

BlueCross BlueShield of South Carolina is seeking a Health Information Coder to perform validation reviews of DRG, APC, and Never Events, coordinating rate adjustments with the claims area and producing monthly/quarterly reports on trends and savings.

This full-time remote role requires strong medical records and coding knowledge, plus experience with HIPAA and contract evaluations. You will support multiple lines of business and contribute to cost containment and compliance.