Location:
Can live anywhere in SC or bordering NC as long as they are able to commute to the worksite location as needed.   Remote ok, but hybrid preferred

Pay:
$36 /hour + optional medical, dental, vision, 401(k) match

Overview
Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events for all lines of business. Coordinates rate adjustments with claims areas and provides monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues and coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department.

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

• 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 - 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

Preferred Skills

• Certification such as RHIT, RHIA, CIC, CPMA, or CPC (top search credentials)

Why Should I Apply?
This role offers an opportunity to contribute to healthcare quality and cost management through validation reviews and coding expertise. Join a team focused on impactful healthcare outcomes and professional growth.

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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