Spectraforce Technologies

Position Title: Medical Billing Specialist Work Location: Livermore, CA Assignment Duration: 5+ Months Work Schedule: Monday-Friday, 6:00 AM-2:30 PM PST Work Arrangement: 100% Onsite Position Summary: The Insurance Data Management Specialist is responsible for the setup, maintenance, auditing, and optimization of payor-related system configurations across revenue cycle platforms. This role ensures accurate implementation of payor contracts, reimbursement methodologies, billing rules, fee schedules, and claims processing requirements to support compliant and efficient revenue cycle operations. Key Responsibilities Configure and maintain payor plans, reimbursement methodologies, fee schedules, contractual allowances, and billing rules. Implement new payor contracts and update existing configurations based on contract amendments and reimbursement changes. Support Billing, VOB, Prior Authorization, and Collections teams with insurance research and payer-related inquiries....

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

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...