Quality Medical Auditor Coding Specialist

Summary

Performs validation reviews of Diagnosis Related Groups (DRG) Adaptive Predictive Coding (APC) and Never Events (inexcusable outcomes in a healthcare setting) 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.

Description

Why should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve been part of the national landscape for more than seven decades with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nations leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy consider joining our team!

Position Purpose :

Performs validation reviews of Diagnosis Related Groups (DRG) Adaptive Predictive Coding (APC) and Never Events (inexcusable outcomes in a healthcare setting) 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.

Location :

This role is located at 2401 Faraway Drive Columbia SC 29229. There is the potential for remote work.

What Youll Do :

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

To Qualify For This Position Youll Need The Following :

Our Comprehensive Benefits Package Includes The Following :

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

What We Can Do for You :

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next :

After submitting your application our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age race color national origin sex religion veteran status disability weight sexual orientation gender identity genetic information or any other legally protected status. Additionally as a federal contractor the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities pregnant individuals individuals with pregnancy-related conditions and individuals needing accommodations for sincerely held religious beliefs provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment please email or call ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Heres moreinformation .

Some states have required notifications. Heres more information.

Required Experience :

IC

Key Skills

Quality Assurance,Quality Inspection,Calipers,ISO 9001,Quality Audits,Process Mapping,Fair Housing Regulations,Quality Control,Underwriting,cGMP,As9100,Manufacturing

Employment Type : Full-Time

Experience : years

Vacancy : 1