What are the responsibilities and job description for the Medical Review Auditor position at CEI?
Medical Review Auditor
Job at a Glance
- Location: South Carolina or bordering North Carolina; potential for remote work, but onsite preferred
- Contract: W2 only,
- Pay: $36.00 /hour optional medical, dental, vision, 401(k) match
Overview
Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events in a healthcare setting. Coordinates rate adjustments with claims areas and provides reports on trends, outcomes, and savings impacting medical costs and contracting rates. Serves as a resource for coding issues and manages HIPAA and legal records requests.
Key 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.
Required Skills
- Associate Degree in Nursing or Health Information Management or Graduate of an Accredited School of Nursing
- 3 years medical record management experience including coding and validation review
- Knowledge of DRG reviews and audits
- Ability to coordinate rate adjustments with claims areas
- Experience creating detailed reports on trends and outcomes
Required Education
- Associate Degree - Nursing or Health Information Management or Graduate of an Accredited School of Nursing
Preferred Skills
- RHIT, RHIA, CIC, CPMA, or CPC certification
- Experience with HIPAA compliance and legal records requests
- Ability to work independently and manage multiple priorities
Why Should I Apply?
This position offers an opportunity to work in a critical healthcare review role with potential for remote work and career growth. Join a team focused on improving healthcare outcomes and cost management.
About CEI:
As a trusted technology partner, CEI delivers solutions that help our customers transform their business and achieve meaningful results. From strategy and custom application development through application management - our technology and digital experience services are tailored to meet each unique need of our customers. Our staffing solutions bring specialized skills to complement our customers' workforce and project requirements.
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Salary : $36