Quality Medical Auditor

BlueCross BlueShield of South Carolina

. Determine methodology to identify cases for validation review .

Posted 11/12/2026full-timeRemote • South Carolina • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical records management, coding methodologies, and HIPAA compliance while effectively conducting validation reviews and coordinating with claims areas. Strong analytical and communication skills are essential for creating reports and resolving coding issues.

Highest-signal resume keywords

Medical Records ManagementCoding MethodologiesValidation Review ExperienceHIPAA ComplianceContract Evaluations

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical CodingValidation ReviewRecords RetrievalClaims ProcessingDocument ManagementData AnalysisRate AdjustmentsTrend ReportingContracting RatesInpatient Experience

Soft Skills

Excellent CommunicationOrganizational SkillsCustomer ServiceAnalytical ThinkingGood Judgment

Certifications & Qualifications

RHIARHITCPCCICCPMAActive RN Licensure

Industry Keywords

Healthcare ServicesLegal Records RequestsConfidential InformationClaims AdjudicationMedical Cost Savings

About the role

Key responsibilities & impact

Determine methodology to identify cases for validation review
Conduct validation reviews and coordinate rate adjustments with claims areas
Create monthly and quarterly reports on records review, outcomes, trends, and savings impacting medical costs and contracting rates
Manage records retrieval, release, HIPAA compliance, and document management
Serve as an expert resource on medical records and coding methodologies and procedures
Coordinate HIPAA and legal records requests for Healthcare Services and the Legal Department
Serve as a resource in resolving coding issues

Requirements

What you’ll need

Associate's in a job related field
2 years job related work experience may serve as degree equivalency
3 years medical record management to include coding and validation review experience
Excellent verbal and written communication, organizational, customer service, and analytical or critical thinking skills
Good judgment
Ability to handle confidential or sensitive information with discretion
Extensive medical records and coding knowledge
Working knowledge of contract evaluations, claims processing and adjudication practices
One of: RHIA, RHIT, CPC, CIC, CPMA, active unrestricted RN licensure from the United States and state of hire, or active compact multistate unrestricted RN license under the Nurse Licensure Compact
Inpatient experience preferred

Benefits

Comp & perks

Subsidized health plans, dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more