BlueCross BlueShield of South Carolina

Internal Reference Number: R1049005 Summary We are currently hiring for a Medical Coding Specialist to join BlueCross BlueShield of South Carolina. In this role as a Medical Coding Specialist, you will review medical documentation to perform a variety of coding validations for multiple lines of business under Medicare/TRICARE to determine accuracy of billing and payment, reassign and sequence diagnostic and procedural codes using universally recognized coding system as appropriate, and compile and analyze statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare/TRICARE payments.Description Location This position is full-time (40 hours/week) Monday-Friday from 8:00am-4:30pm EST and will be hybrid in Columbia, SC. What You'll Do: Determines methodology to identify cases for DRG, HIPPS, HCPCS, RUG, and APC validation. Conducts targeted coding, documentation reviews, and validation...

Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, 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 nation's 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! This open position is within one of our subsidiary companies called CGS Administrators. CGS has been a proven provider of administrative and business services for state Medicaid agencies, managed care organizations, commercial health plans, Medicaid members,...

Medical Coding Specialist We are currently hiring for a Medical Coding Specialist to join BlueCross BlueShield of South Carolina. In this role, you will review medical documentation to perform a variety of coding validations for multiple lines of business under Medicare/TRICARE to determine accuracy of billing and payment, reassign and sequence diagnostic and procedural codes using universally recognized coding system as appropriate, and compile and analyze statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare/TRICARE payments. Location: This position is full-time (40 hours/week) Monday-Friday from 8:00am-4:30pm EST and will be hybrid in Columbia, SC. What You'll Do: Determines methodology to identify cases for DRG, HIPPS, HCPCS, RUG, and APC validation. Conducts targeted coding, documentation reviews, and validation reviews coordinating rate adjustments and adjudication of corresponding...

Job Title 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. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've 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 nation's 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...

Summary We are currently hiring for a Medical Coding Specialist to join BlueCross BlueShield of South Carolina. In this role as a Medical Coding Specialist, you will review medical documentation to perform a variety of coding validations for multiple lines of business under Medicare/TRICARE to determine accuracy of billing and payment, reassign and sequence diagnostic and procedural codes using universally recognized coding system as appropriate, and compile and analyze statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare/TRICARE payments. Description Location This position is full-time (40 hours/week) Monday-Friday from 8:00am-4:30pm EST and will be hybrid in Columbia, SC. What You'll Do: Determines methodology to identify cases for DRG, HIPPS, HCPCS, RUG, and APC validation. Conducts targeted coding, documentation reviews, and validation reviews coordinating rate...

Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've 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 nation's 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! Description 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...

Quality Medical Auditor - Coding Specialist life insurance, paid time off, 401(k), remote work United States, South Carolina, Columbia Jan 01, 2026 Internal Reference Number: R1048322 Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've 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 nation's 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! Description Position Purpose : Performs validation reviews of Diagnosis Related Groups...

A leading healthcare provider in Columbia, SC, is seeking a Quality Medical Auditor - Coding Specialist. This role involves conducting validation reviews of medical records, coordinating rate adjustments, and managing HIPAA compliance. Candidates should have at least 3 years of relevant experience and an associate's degree in a related field. The position offers a comprehensive benefits package and potential for remote work. #J-18808-Ljbffr

Quality Medical Auditor - Coding Specialist Join to apply for the Quality Medical Auditor - Coding Specialist role at BlueCross BlueShield of South Carolina . Summary 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 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 we've 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 nation's leading administrators of government contracts. We operate...