Quality Medical Auditor - Inpatient Coding

Overview BlueCross BlueShield of South Carolina is a leading national insurance company that has served the South Carolina community for more than seventy years. We are the largest insurance company in South Carolina, a leading administrator of government contracts, and operate one of the most sophisticated data processing centers in the Southeast. With a diverse family of subsidiary companies we deliver outstanding service to our customers and build on diverse business strengths. Position Purpose Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (serious, preventable medical errors) 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. Location This is a remote position, Monday - Friday from 8:30am - 5pm. What You’ll Do Determine methodology to identify cases for validation review. Conduct validation reviews and coordinate rate adjustments with appropriate claims area. Create 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. Manage records retrieval, release, HIPAA compliance, and all aspects of document management. Serve as expert resource on methodology and procedures for medical records and coding issues. Qualifications Required Education: Associate’s in a job‑related field. Degree Equivalency: 2 years of job‑related work experience. Required Work Experience: 3 years medical record management, including coding and validation review experience. Skills and Abilities: Excellent verbal and written communication, organizational, customer service, and analytical or critical thinking skills; good judgment; ability to handle confidential or sensitive information with discretion; extensive medical records and coding knowledge; working knowledge of contract evaluations, claims processing, and adjudication practices. Required Licenses and Certificates: Registered health information administrator (RHIA) OR Registered health information technician (RHIT) OR Certified Professional Coder (CPC) OR Certified Inpatient Coder (CIC) OR Certified Professional Medical Auditor (CPMA) OR active, unrestricted RN licensure from the United States in the hiring state, OR active compact multi‑state unrestricted RN license as defined by the Nurse Licensure Compact (NLC). Benefits Subsidized health plans, dental and vision coverage 401(k) retirement savings plan with company match Life insurance Paid Time Off (PTO) On‑site cafeterias and fitness centers in major locations Education assistanceService recognition National discounts to movies, theaters, zoos, theme parks and more Company Culture We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. Next Steps After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy‑related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email View email address on click.appcast.io or call View phone number on click.appcast.io with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case‑by‑case basis. We participate in E‑Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here’s more information. Some states have required notifications. Here’s more information. #J-18808-Ljbffr BlueCross BlueShield of South Carolina