Spectraforce Technologies

Role Name: Quality Medical Auditor Location: Columbia, SC 29223 Work Environment: Remote (Preferred Onsite) Schedule: Mon - Fri, 8AM-4PM Contract length: 4 months assignment with possible conversion Job 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 Day to Day: 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...

Spectraforce Technologies in Columbia, SC seeks a Quality Medical Auditor to perform validation reviews of DRG, APC, and Never Events across lines of business. You will coordinate rate adjustments with claims and produce monthly and quarterly reports. The role requires strong knowledge of medical record coding, HIPAA compliance, and data analysis. This contract is 4 months with possible conversion, with a remote-friendly onsite-focused schedule. #J-18808-Ljbffr

Spectraforce Technologies seeks a Quality Assurance Coder/Auditor to lead risk adjustment coding quality within Medicare/Medicaid programs. You will review records, perform audits, and educate providers on accurate diagnoses and documentation to improve coding accuracy. This hybrid Phoenix role requires travel to physician offices weekly, a minimum of 5 years of medical coding with HCC experience, and CCS-P/CRC/CPC/COC credentials. The position is 6 months with potential extension. #J-18808-Ljbffr

Job Title: Quality Assurance Coder/Auditor Location: Phoenix, AZ (Hybrid, Required to Travel into the office 1 x per week) Duration: 6 Months (possibility of extension or conversion) Department: Medicare/ Medicaid Purpose The Quality Assurance Coder/Auditor will develop a risk mitigation and provider education program. On a regular basis, the Coder/Auditor will educate primary care providers and their staff on their historical diagnoses/coding error trends, accurate completion of medical record documentation, and at‑risk code identification and risk mitigation. This includes the review, analysis, and recommended coding based on medical and clinical diagnoses, procedures, injuries, or illnesses contained in medical records and supporting documentation. The Quality Assurance Coder/Auditor will perform risk mitigation analysis using available vendor tools to identify at‑risk single occurrences of HCCs and OIG targets. Deletions will be submitted for unsupported/invalid diagnoses....

Job Title: Quality Assurance Coder/Auditor Location: Phoenix, AZ (Hybrid, Required to Travel into the office 1 x per week) Duration: 6 Months (possibility of extension or conversion) Department : Medicare/ Medicaid Purpose of the job: The Quality Assurance Coder/Auditor will develop a risk mitigation and provider education program. On a regular basis, Coder/Auditor will educate primary care providers and their staff on their historical diagnoses/coding error trends, accurate completion of medical record documentation, and at-risk code identification and risk mitigation, . This includes the review, analysis, and recommended coding based on medical and clinical diagnoses, procedures, injuries, or illnesses contained in medical records and supporting documentation. The Quality Assurance Coder/Auditor will perform risk mitigation analysis using available vendor tools to identify at-risk single occurrence of HCCs and OIG targets. Deletions will be submitted for...