5 drg validation coding auditor jobs found

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...

Role Name: Quality Medical Auditor Location: Columbia, SC 29223 Work Environment: Remote (Preferred Onsite) Schedule: Mon - Fri, 8AM-4:30PM 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 rate 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...

Role Name: Quality Medical Auditor Location: Columbia, SC 29223 Work Environment: Remote (Preferred Onsite) Schedule: Mon - Fri, 8AM-4:30PM 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 rate adjustments with appropriate claims area. Creates monthly/quarterly reports to present to each line of business providing information on records review, outcomes, trends, and...

Job Description Job Description Medical Coder W2 Contract – This will convert to a full-time role. Pay rate: $36 Location: Columbia South Carolina (on-site) - Hybrid Hours: Monday-Friday 8:00am - 4:30pm Do you have any of these certifications on your resume: RHIT, RHIA, CIC, CPMA, or CPC? If so… we want to talk to you! About the Role: Step into a key role within our healthcare organization, where you’ll help safeguard the accuracy and reliability of medical coding and billing operations. In this position, you’ll oversee detailed validation reviews across multiple business areas, drive initiatives that support cost efficiency, and uphold critical regulatory requirements including HIPAA compliance. This is an excellent opportunity to strengthen healthcare quality, support financial integrity, and expand your expertise in medical auditing and coding oversight. Responsibilities In this role, you will take the lead in performing detailed reviews of medical coding accuracy,...

Inspire health. Serve with compassion. Be the difference. Job Summary Responsible for leading coding teams, coder training, work que management, performing prebill and second-level coding reviews utilizing auditing software and documents findings to improve CC/MCC capture, Risk Variable capture, HAC/PSI, HCC and Quality Indicator validation. Uses knowledge of coding and compliance guidelines to identify potential documentation, coding and reimbursement issues and report these to coding leadership. Employ critical thinking skills to alert coding leadership to any trends identified in their reviews and to make suggestions for continual process improvement. Reviews and responds to inpatient denials as needed. Performs Inpatient coding by assigning ICD-CM and ICD-PCS codes as well as DRG assignment. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference....