Remote Outpatient Coding Validation Specialist

Machinify; United States; Remote; USD 85,000 - 100,000; Full time

Benefits offered by this job

Work from anywhere in the US

Top Medical/Dental/Vision offerings

FSA/HSA

Tuition reimbursement

Competitive salary, 401(k) with match

Health and wellness benefits

Job summary

Machinify is seeking a Coding Validation Specialist to perform comprehensive outpatient payment validation reviews across a US remote framework. You will ensure accurate coding, billing, and documentation for outpatient services, applying APCs, EAPGs, CPT, and HCPCS guidelines.

You will document audit findings, reference payer policies, and leverage ICD-10-CM/PCS and Medicare rules to support reimbursement impact. Strong detail orientation and collaboration are essential.

Qualifications

• Associate or bachelor's in HIM or related field.
• 2+ years performing pre-pay or post-pay reimbursement audits.
• Broad outpatient facility auditing across specialty areas.
• Active certification: RHIT, RHIA, CCS or CPC.
• 5–7 years in outpatient facility coding/auditing.
• Strong knowledge of ICD-10-CM/PCS, CPT, and HCPCS guidelines.
• Experience with Medicare LCDs, NCDs, NCCI edits, OPPS, APC.
• Excellent verbal and written communication and attention to detail.

Responsibilities

• Review medical records to validate coding accuracy and reimbursement.
• Apply guidelines across outpatient services incl IR, Radiation Oncology, injections, infusions, surgeries.
• Demonstrate expertise in OPPS, APC, and EAPG methodologies.
• Apply NCCI edits and modifier usage; interpret LCDs and NCDs.
• Produce clear audit findings with reimbursement impact.
• Develop rationales for coding changes with credible sources.
• Collaborate in a production-driven environment.
• Maintain accuracy and thorough documentation.
• Utilize Grouper/Pricer and ICD-10 encoders; AHIMA standards.

Skills

ICD-10-CM/PCS

CPT guidelines

HCPCS guidelines

Auditing tools

Communication skills

Education

Associate's or Bachelor's in Health Information Management

Tools

3M Encoder

Grouper/Pricer

TrueBridge

Job description

Machinify is seeking a Coding Validation Specialist to perform comprehensive outpatient payment validation reviews across a US remote framework. You will ensure accurate coding, billing, and documentation for outpatient services, applying APCs, EAPGs, CPT, and HCPCS guidelines.

You will document audit findings, reference payer policies, and leverage ICD-10-CM/PCS and Medicare rules to support reimbursement impact. Strong detail orientation and collaboration are essential.