Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events across all lines of business. Coordinates rate adjustments with claims teams and provides monthly and quarterly reports on trends. Serves as a resource for resolving coding issues and coordinates HIPAA and legal records requests for Healthcare Services and the Legal Department.
Key responsibilities include determining methodology for identifying cases for validation review, conducting validation reviews, coordinating rate adjustments with claims areas, preparing reports on records review outcomes, trends, and savings, and managing records retrieval, release, HIPAA compliance, and document management.
Required skills
- Develops methodologies
- Follows processes
- Responds to inquiries
- Writes for impact
- Strong understanding of healthcare coding and validation review processes
- Ability to coordinate with claims and legal departments
- Excellent report creation and presentation skills
- Knowledge of HIPAA compliance and legal records management
- Effective communication skills
- Ability to work independently and as part of a team
Required education
- Associate degree in Nursing or Health Information Management, or graduate of an accredited school of nursing
Required experience
- 3 years of medical record management experience, including coding and validation review
Preferred credentials
- RHIT, RHIA, CIC, CPMA, or CPC
Optional medical, dental, and vision coverage
- 401(k) match
Location
South Carolina, US
Employment Type
Contractor
Experience Level
Associate
Remote work allowed
Yes
Posted
2 weeks ago