Remote Behavioral Health Coding Validation Specialist

Machinifyinc; United States; On-site; USD 90,000 - 100,000; Full time

Benefits offered by this job

Work from anywhere in the US

Medical/Dental/Vision coverage

FSA/HSA

Tuition reimbursement

401(k) with company match

Health and wellness perks

Flexible work environment

Job summary

Machinify is seeking a Coding Validation Specialist to validate behavioral health and SUD claims, leveraging expertise in DSM-5, CPT, and HCPCS to ensure accurate coding and compliant documentation across the payer landscape.

The role supports AI-assisted review, participates in coding change rationales, and maintains strict confidentiality while optimizing reimbursement and quality. Remote work from anywhere in the US is offered.

Qualifications

• Active nursing license (RN/LPN) in good standing or coding certification.
• Minimum of three years in coding/auditing behavioral health/SUD claims.

Responsibilities

• Performs analysis and review of claim information and medical records to validate codes support payment for behavioral health and/or SUD services.
• Maintains knowledge of CPT/HCPCS Level II coding conventions for behavioral health and SUD.
• Analyzes, reviews, and resolves coding issues related to reimbursement and compliance.
• Validates patient data by comparing claims with treatment plans and level-of-care docs.
• Develops rationale for coding changes citing official guidelines and references.
• Analyzes claim characteristics impacting reimbursement including revenue code and CPT/HCPCS pairings.
• Maintains accuracy and quality standards in coding review outcomes.
• Applies 42 CFR Part 2 and MHPAEA confidentiality considerations.
• Uses Grouper/Pricer, ICD-10-CM encoder, and Office tools.
• Adheres to AHIMA ethical coding standards.

Skills

Nursing license

Coding certification

3+ years experience

DSM-5/ICD-10-CM knowledge

APC knowledge

AI-powered search tools

Communication skills

Analytical thinking

Education

Health information management / nursing / medical coding degree

CBHCS or equivalent credential

2+ years post-adjudication/outpatient review experience

Tools

Grouper/Pricer

ICD-10-CM encoder

Microsoft Office

Job description

Machinify is seeking a Coding Validation Specialist to validate behavioral health and SUD claims, leveraging expertise in DSM-5, CPT, and HCPCS to ensure accurate coding and compliant documentation across the payer landscape.

The role supports AI-assisted review, participates in coding change rationales, and maintains strict confidentiality while optimizing reimbursement and quality. Remote work from anywhere in the US is offered.