Job Description

Greetings!

Hope you're doing well. We are excited to announce an opening for an Auditor, Quality Medical to join our team onsite in Columbia, SC .

If you have strong expertise in DRG/APC validation, medical record auditing, and HIPAA compliance , this is an excellent opportunity to advance your career in a high-impact healthcare role.

About the Role:

The Auditor, Quality Medical plays a key role in ensuring accuracy in medical coding, reducing medical costs, and improving documentation integrity . This position involves reviewing complex medical records, validating DRG/APC outcomes , analyzing trends, and supporting legal/HIPAA compliance activities.

Key Responsibilities

✔ 75% – Validation & Reporting

• Perform validation reviews for DRG, APC, and Never Events across all lines of business
• Identify methodology for case selection and coordinate rate adjustments with claims teams
• Prepare monthly & quarterly trend reports outlining outcomes, savings, and coding accuracy insights

✔ 15% – Records Management & HIPAA

• Manage records retrieval, release, and document control
• Ensure full compliance with HIPAA regulations

✔ 10% – Subject Matter Expertise

• Serve as a resource for coding methodology, medical record processes, and documentation issues

What We’re Looking For

• Experience in medical record management , coding , and validation review
• Strong understanding of DRG/APC guidelines , coding accuracy, and healthcare documentation
• Ability to analyze large volumes of clinical data and identify trends
• Knowledge of HIPAA, compliance standards, and claims processes
• Excellent communication and organizational skills

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