Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior), making us the only health insurance company in South Carolina with that rating. We’re the largest insurance company in South Carolina …and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allow us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Job Title: Auditor, Quality Medical

Position Details:

• MAX PAY RATE - $36.00/HR.
• CONTRACT TO HIRE.
• WORK SCHEDULE: MONDAY - FRIDAY, 8 AM - 4:30 PM.
• MANAGER WILL CONDUCT TWO INTERVIEWS, 1ST ROUND VIA TEAMS, 2ND ROUND WILL BE ONSITE WITH MANAGER AND CODER.
• WILL HAVE POTENTIAL FOR REMOTE WORK BUT PREFERS ONSITE.
• MUST BE LOCAL TO THE AREA.
• IF GIVEN REMOTE OPTION – BCBS WILL PROVIDE THE EQUIPMENT. 
• The normal day is DRG reviews and audits.

Duties:

• Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (inexcusable outcomes in a healthcare setting) 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.
• 75% 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.
• 15% Manages records retrieval, release, HIPAA compliance, and all aspects of document management.
• 10% Serves as expert resource on methodology and procedures for medical records and coding issues. 

Required Training: 

• Registered Records Administrator or Technician, OR active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR Certified Codi.

Skills and Abilities:

• 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.
• Develops methodologies.
• Follows processes.
• Responds to Inquiries.
• Writes for Impact.

Pay Transparency:

• This is the pay range that Magnit reasonably expects to pay someone for this position is $28.86/hour - $36.00/hour W-2.
• Benefits: Medical, Dental, Vision, 401K (provided minimum eligibility hours are met).

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found dedication, work ethics and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more.

Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty. If you're ready to join a diverse company with secure, community roots and an innovative future, apply for a position now!