New 
Auditor, Quality Medical
 Spectraforce Technologies | |
 United States, South Carolina, Columbia | |
 Jan 23, 2026 | |
| 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.*75% 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.*15% Manages records retrieval, release, HIPAA compliance, and all aspects of document management.*10% Serves as expert resource on methodology and procedures for medical records and coding issues., Education: Required Education: Associate Degree - Nursing or Health Information Management or Graduate of an Accredited School of NursingRequired Work Experience: 3 years medical record management to include coding and validation review experience. | |