Quality Validation Specialist

Machinify
United States
Workplace: RemoteFull timeUSD 105,000+ annuallyFunction: Quality & Regulatory (Non-Software)Experience: 5+ yearsEducation: bachelorsSkills: ["Communication","Analytical thinking","Problem-solving","Training","Coaching"]

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.

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FursaFursa
Machinify
Machinify
3 months ago

Quality Validation Specialist

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Last checked: 2 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
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