Join our dynamic team in Columbia, SC, a vibrant city known for its rich history and welcoming community. We are seeking a dedicated professional to perform critical validation reviews and manage records for our healthcare services.
Duties
Perform validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events for all lines of business. Coordinate rate adjustments with claims areas and provide monthly and quarterly reports outlining trends. Serve as a resource in resolving coding issues and coordinate HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department. Determine methodology to identify cases for validation review and conduct validation reviews/coordinate rate adjustments with the appropriate claims area. Create monthly/quarterly reports to present to each line of business, providing information on records review, outcomes, trends, and savings impac...