• Quality Review Auditor

    US Tech Solutions (Columbia, SC)


    Duration: 3+ Months Contract (Possible temp to hire)

    Job Description:

    + MONDAY-FRIDAY, 8AM-4:30PM.

    + License/Certification in: RHIT, RHIA, CIC, CPMA, or CPC.

    + A typical day would like in this role: The normal day is DRG reviews and audits.

    + 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.

    Responsibilities:

    + 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 impact medical costs and contracting rates.

    + Manages records retrieval, release, HIPAA compliance, and all aspects of document management.

    + Serves as expert resource on methodology and procedures for medical records and coding issues.

    Experience:

    + 3 years medical record management to include coding and validation review experience.

    Skills:

    + Develops methodologies

    + Follows processes

    + Responds to Inquiries

    + Writes for Impact.

    Education:

    + Associate Degree - Nursing or Health Information Management or Graduate of an Accredited School of Nursing Required Work Experience.

    About US Tech Solutions:

    US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com) .

     

    US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.