Remote Coding Validation & QA Specialist

The Rawlings Group; United States; Remote; USD 94,500 - 115,500; Full time

Benefits offered by this job

PTO and holidays

Health, vision and dental coverage

401(k) with company match

Tuition reimbursement

Life insurance and disability benefits

Remote or hybrid work options

Job summary

Machinify is seeking a Quality Validation Specialist to review outpatient coding validation audits, ensure accuracy, and support continuous quality improvement. You will evaluate auditor performance, provide coaching, and maintain QA tools and documentation.

The role emphasizes adherence to Official Coding Guidelines, CMS rules, and AHIMA/AAPC standards. You will work with leadership to refine audit methodologies, standardize scoring, and monitor QA metrics while staying current on Medicare

Qualifications

• Requires AHIMA/AAPC certification or active credentials
• Minimum 5 years of hospital outpatient coding experience in OPPS/Audit
• Strong knowledge of CPT, HCPCS Level II, ICD-10-CM and NCCI edits
• Experience with encoder/auditing tools like Optum, TrueBridge, 3M

Responsibilities

• Perform secondary reviews of outpatient coding validation audits for accuracy and compliance
• Evaluate auditor performance against quality benchmarks and provide actionable feedback
• Develop and maintain QA tools, scorecards, and documentation standards
• Collaborate with leadership to improve audit methodologies and coding guidance
• Monitor QA metrics and report trends to leadership
• Validate CPT, HCPCS Level II, and ICD-10-CM coding accuracy with appropriate references

Skills

Coding knowledge

Analytical thinking

Communication skills

Independent worker

Education

Health Information Management degree

Tools

Optum

3M

TrueBridge

Job description

Machinify is seeking a Quality Validation Specialist to review outpatient coding validation audits, ensure accuracy, and support continuous quality improvement. You will evaluate auditor performance, provide coaching, and maintain QA tools and documentation.

The role emphasizes adherence to Official Coding Guidelines, CMS rules, and AHIMA/AAPC standards. You will work with leadership to refine audit methodologies, standardize scoring, and monitor QA metrics while staying current on Medicare