New

Quality Medical Auditor

Spectraforce Technologies
United States, South Carolina, Columbia
Dec 13, 2025
Role Name: Quality Medical Auditor Location: Columbia, SC 29223 Work Environment: Onsite (Potential for remote) 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 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. 15% Manages records retrieval, release, HIPAA compliance, and all aspects of document management. 10% Serves as expert resource on methodology and procedures for medical records and coding issues. Required Education: Associate Degree - Nursing or Health Information Management or Graduate of an Accredited School of Nursing Required Work Experience: 3 years medical record management to include coding and validation review experience. License/Certification required: Certified Coding Specialist or RN