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This role conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. It is a remote position with field-based responsibility, requiring travel to provider offices to retrieve, review, and validate medical records on-site in or around the Sumter, SC area and surrounding counties.
The position performs moderately complex administrative and operational tasks in a structured environment with a focus on accuracy, compliance, and efficiency.
Schedule
Monday through Friday, 8:00 am to 4:30 pm EST, with occasional flexibility based on business needs.
Key Duties
- Collect medical records and conduct research to ensure accuracy of member information and obtain provider signatures.
- Upload verified documents to a centralized repository within 24 hours.
- Follow state and federal regulations, internal policies, and guidelines while retrieving medical records.
- Interpret and apply departmental procedures to complete assignments accurately and efficiently.
- Use a laptop, portable scanner, and encrypted flash drive to retrieve and upload medical records into a database.
- Conduct a high volume of calls to physician offices by phone and email to meet deadlines.
- Maintain strict confidentiality and safeguard PHI in compliance with HIPAA guidelines.
- Independently manage workload within defined service level expectations.
Travel
Reside within Sumter, SC or surrounding areas, including Orangeburg, Bamberg, Hampton, Allendale, Colleton, Calhoun, or Beaufort. Travel and occasional overnight stays may be required up to 60% of the time during peak season.
- 1 or more years of customer service experience
- 1 or more years of medical records experience
- Daily use of Microsoft Teams and Outlook to coordinate meetings, manage calendars, and communicate with supervisors and peers
- Experience handling a high volume of tasks and follow-up while maintaining a high standard of professional conduct
- Experience articulating information to internal peers and external partners
- Knowledge or experience in a healthcare or managed care environment, such as provider offices, billing, coding, or release of information
- Valid state driver's license
- Personal vehicle liability insurance meeting required limits
- Associate's degree or higher in a related field preferred
- Knowledge or experience with ICD-9/10 codes preferred
- Knowledge of medical terminology preferred
- Experience with EMR systems preferred
- Medical, dental, and vision insurance
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Volunteer time off
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Internet expense support for associates in select states
Location
South Carolina, US
Employment Type
Full-time
Experience Level
Associate
Salary Range
$40,000 - $52,300
Remote work allowed
Yes
Posted
2 weeks ago