3 cpma certified professional medical auditor jobs found in Columbia, SC

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 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 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...