Machinify

1 month ago

Quality Validation Specialist

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 22 hours agoStatus: Live

Job Summary

Join Machinify as a Quality Validation Specialist focusing on reviewing outpatient coding validation audits for APCs, EAPGs, CPT, HCPCS Level II, and ICD-10-CM. You’ll coach auditors, track QA metrics, develop tools and scorecards, and partner with leadership to standardize workflows, ensure compliance with AHIMA/AAPC and CMS guidelines, and drive continuous quality improvements in Medicare OPPS reimbursement.

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Quality & Regulatory (Non-Software)

Key Responsibilities

•Performs secondary reviews of completed outpatient coding validation audits to verify coding accuracy, supporting rationale, and compliance with official coding guidelines, payer policies, reimbursement methodologies, and internal audit standards.
•Evaluates auditor performance against established quality and accuracy benchmarks, identifying trends, educational opportunities, and areas requiring corrective action.
•Provides detailed, constructive feedback and coaching to auditors to promote consistency, accuracy, and appropriate interpretation and application of coding and billing guidelines.
•Develops, maintains, and enhances quality assurance tools, scorecards, audit tracking mechanisms, and documentation standards to support objective and consistent review processes.
•Collaborates with leadership and operational teams to improve audit methodologies, clarify coding guidance, standardize processes, and support continuous quality improvement initiatives.

Pay and Benefits

Salary: USD 105,000 annually

Perks:Health Insurance401kRemote WorkPaid Holidays

Key Requirements

•Associate’s or Bachelor’s degree in Health Information Management, Healthcare Administration, or a related field preferred.
•Current certification through AHIMA and/or AAPC required, including RHIA, CCS, or CPC.
•Minimum of 5 years of hospital outpatient coding experience within OPPS reimbursement methodologies and/or outpatient/APC validation auditing experience.
•Extensive knowledge of CPT, HCPCS Level II, ICD-10-CM, NCCI edits, and appropriate modifier usage.
•Experience using encoder and auditing tools such as Optum, TrueBridge, and/or 3M.

Experience:5+ yearsHealthcare

Education:Bachelor's

Skills:CommunicationAnalytical thinkingProblem-solvingTrainingCoaching

Certifications:RHIACCSCPC

Languages:English

Tech Stack:OptumTrueBridge3MCPTHCPCSICD-10-CM

Company Brief

Machinify

Provides AI-driven predictive maintenance and asset-monitoring solutions for manufacturing and industrial operations, using IoT sensor data and machine learning to reduce downtime, optimize performance, and extend equipment life.

Industry: Industrial Automation

Website

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Machinify

1 month ago

Quality Validation Specialist

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 22 hours agoStatus: Live

Job Summary

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Quality & Regulatory (Non-Software)

Key Responsibilities

•Performs secondary reviews of completed outpatient coding validation audits to verify coding accuracy, supporting rationale, and compliance with official coding guidelines, payer policies, reimbursement methodologies, and internal audit standards.
•Evaluates auditor performance against established quality and accuracy benchmarks, identifying trends, educational opportunities, and areas requiring corrective action.
•Provides detailed, constructive feedback and coaching to auditors to promote consistency, accuracy, and appropriate interpretation and application of coding and billing guidelines.
•Develops, maintains, and enhances quality assurance tools, scorecards, audit tracking mechanisms, and documentation standards to support objective and consistent review processes.
•Collaborates with leadership and operational teams to improve audit methodologies, clarify coding guidance, standardize processes, and support continuous quality improvement initiatives.

Pay and Benefits

Salary: USD 105,000 annually

Perks:Health Insurance401kRemote WorkPaid Holidays

Key Requirements

•Associate’s or Bachelor’s degree in Health Information Management, Healthcare Administration, or a related field preferred.
•Current certification through AHIMA and/or AAPC required, including RHIA, CCS, or CPC.
•Minimum of 5 years of hospital outpatient coding experience within OPPS reimbursement methodologies and/or outpatient/APC validation auditing experience.
•Extensive knowledge of CPT, HCPCS Level II, ICD-10-CM, NCCI edits, and appropriate modifier usage.
•Experience using encoder and auditing tools such as Optum, TrueBridge, and/or 3M.

Experience:5+ yearsHealthcare

Education:Bachelor's

Skills:CommunicationAnalytical thinkingProblem-solvingTrainingCoaching

Certifications:RHIACCSCPC

Languages:English

Tech Stack:OptumTrueBridge3MCPTHCPCSICD-10-CM

Company Brief

Machinify

Industry: Industrial Automation

Website