5 drg validation coding auditor jobs found

Job Description Job Description Medical Auditor W2H Contract to Hire Pay rate: $36/hr Location: Columbia South Carolina (remote option for local candidates) Join our dynamic healthcare team as a Quality Medical Auditor and play a critical role in ensuring the accuracy and integrity of medical coding and billing processes. You will be instrumental in validating complex diagnoses, coding accuracy, and identifying opportunities for cost savings, all while supporting compliance and legal standards. This position offers a unique opportunity for career growth in healthcare auditing, coding accuracy, and data analysis. Key Responsibilities: Conduct comprehensive validation reviews of Diagnosis Related Groups (DRGs), Adaptive Predictive Coding (APC), and Never Events (medically inexcusable outcomes) across all lines of business, ensuring coding accuracy and compliance. Develop and implement robust methodologies for case selection to identify records for validation reviews...

Job Description Job Description Job Title: Medical Coding and Compliance Analyst (RN) Location: Columbia, SC - Hybrid (3 days onsite) Contract: W2 - Contract to Hire - 6 months to start Pay Rate:  $31/hour This role is a pivotal function within our compliance team, focusing on the rigorous validation of medical coding data. The primary objective is to safeguard billing accuracy and ensure adherence to all relevant healthcare regulations by performing detailed reviews of classification systems such as Diagnosis Related Groups (DRG) and Adaptive Predictive Coding (APC). The Analyst serves as the critical link between audit findings and operational claims adjustments. The successful candidate will own several key areas of responsibility: We are seeking a detail-oriented professional with a strong background in medical records and compliance. Audit & Validation     Develop and execute methodologies to select cases for review. Validate the accuracy of medical...

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...

A healthcare provider in South Carolina is seeking a qualified professional to lead coding teams, manage coding processes, and perform audits on inpatient records. The ideal candidate holds an Associate's degree or equivalent and has a minimum of 4 years' experience in inpatient coding. This role involves mentoring coders, validating DRGs, and collaborating with clinical teams, all while ensuring compliance with Medicare requirements. Join us and help transform healthcare in our community. #J-18808-Ljbffr

Inspire health. Serve with compassion. Be the difference. Job Summary Responsible for leading coding teams, coder training, work queue 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 Conducts review and audit of discharged inpatient records (prebill and retrospective reviews) to validate the coding/DRG assignment according to official coding...