Duration: 3+ months (possible contract to hire)
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 teams, provides monthly and quarterly trend reports, and serves as a resource for resolving coding issues. Manages HIPAA and legal records requests for Healthcare Services and the Legal Department.
Determines the methodology used to identify cases for validation review, conducts validation reviews, coordinates rate adjustments with the appropriate claims area, and prepares reports summarizing records review outcomes, trends, and savings that impact medical costs and contracting rates.
Manages records retrieval, release, HIPAA compliance, and document management. Serves as an expert resource on medical records and coding procedures.
Experience
- 3 years of medical record management experience, including coding and validation review
Skills
- Develops methodologies
- Follows processes
- Responds to inquiries
- Writes clearly and effectively
Education
- Associate degree in Nursing or Health Information Management, or graduate of an accredited school
Schedule
- Monday through Friday, 8:30 AM to 5:00 PM
Location
South Carolina, US
Employment Type
Contractor
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 month ago