Coding Validation Specialist, Behavioral Health, Substance Use Disorder
Posted 3ds ago
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Job Description
Coding validation specialist auditing behavioral health and substance use disorder claims for healthcare intelligence company Machinify. Validating codes, documentation, reimbursement, and regulatory compliance.
Responsibilities:
- Analyze and review claim information and medical records to validate behavioral health and SUD procedure and service codes.
- Maintain expert knowledge of CPT, HCPCS Level II, DSM-5/ICD-10-CM, Official Coding Guidelines, and behavioral health/SUD coding rules.
- Analyze, review, and resolve coding issues related to reimbursement, compliance, and client-specific policies.
- Validate patient data against treatment plans, progress notes, and level-of-care documentation.
- Develop and apply rationale for coding changes affecting APC or EAPG assignments, citing supporting references.
- Analyze claim documentation and revenue-code/CPT-HCPCS pairings affecting reimbursement.
- Maintain accuracy, quality, and production standards and document review outcomes.
- Apply 42 CFR Part 2 confidentiality and MHPAEA considerations.
- Use computer applications, Grouper/Pricer software, ICD-10-CM encoder software, and Microsoft Office.
- Follow AHIMA Standards of Ethical Coding.
Requirements:
- High School Diploma or equivalent GED.
- One of the following: active, unrestricted nursing license (RN or LPN/LVN) in good standing, or national coding certification as RHIA, RHIT, CPC, or CCS.
- Minimum of three years of experience in coding or auditing behavioral health and/or SUD claims.
- Working knowledge of DSM-5 diagnostic coding as applied to ICD-10-CM, and behavioral health/SUD documentation requirements.
- Comprehensive knowledge of the APC structure and regulatory requirements applicable to behavioral health and SUD services.
- Comfort with AI-powered search tools and willingness to learn new technologies.
- Excellent oral and written communication skills.
- Strong analytic and critical thinking skills.
- Ability to work independently and as part of a team in a production environment.
Benefits:
- Work from anywhere in the US! Machinify is digital-first.
- Top Medical/Dental/Vision offerings
- FSA/HSA
- Tuition reimbursement
- Competitive salary
- 401(k) with company match
- Additional health and wellness benefits and perks
- Flexible and trusting environment where you’ll feel empowered to do your best work
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