APC Coding Validation Specialist

Machinify
United States
Workplace: RemoteFull timeUSD 85,000 - 100,000 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Experience: 2-7 yearsEducation: bachelorsSkills: ["Attention to detail","Analytical skills","Communication"]

Validation-focused coding specialist responsible for outpatient payment validation reviews, applying ICD-10-CM/PCS, CPT, HCPCS guidelines and Medicare reimbursement methodologies to ensure accurate, compliant determinations across services such as Interventional Radiology, Oncology, and ambulatory procedures. Collaborates to produce clear audit findings and defend reimbursement decisions within a production-driven healthcare setting.

Loading

Loading job details...

Preparing the role view and application actions.

FursaFursa
Machinify
Machinify
5 months ago

APC Coding Validation Specialist

✓ Verified Job

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

Source: Company careers pageValidated by: Fursa AI
Last checked: 2 hours agoStatus: Live

Job Summary

Validation-focused coding specialist responsible for outpatient payment validation reviews, applying ICD-10-CM/PCS, CPT, HCPCS guidelines and Medicare reimbursement methodologies to ensure accurate, compliant determinations across services such as Interventional Radiology, Oncology, and ambulatory procedures. Collaborates to produce clear audit findings and defend reimbursement decisions within a production-driven healthcare setting.
Location: United States
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)

Key Responsibilities

  • •Conduct comprehensive reviews to validate the accuracy of billed charges against medical documentation, payer policies, coding guidelines, and industry standards to ensure appropriate reimbursement.
  • •Apply coding guidelines across a broad range of outpatient services, including Interventional Radiology, Radiation Oncology, injections and infusions, outpatient surgeries, implants, and observation services (including carve-outs).
  • •Demonstrate a strong working knowledge of outpatient reimbursement methodologies, including Medicare OPPS, APC, and EAPG.
  • •Apply expert-level knowledge of NCCI edits, modifier usage, CPT and HCPCS coding guidelines.
  • •Interpret and apply LCDs and NCDs to support reimbursement decisions.

Pay and Benefits

Salary: USD 85,000 - 100,000 annually
Perks:MedicalDentalVision401k

Key Requirements

  • •Associate’s or Bachelor’s degree in Health Information Management, Medical Coding, or a related field.
  • •At least 2 years of experience performing pre-pay and/or post-pay reimbursement audits.
  • •Broad outpatient facility auditing experience, including Interventional Radiology, injections and infusions, Radiation Oncology, Behavioral Health, and ambulatory surgery.
  • •Active certification including RHIT, RHIA, CCS (AHIMA), and/or CPC.
  • •5-7 years of experience in outpatient facility coding/auditing.
Experience:2-7 yearsHealthcare
Education:Bachelor's
Skills:Attention to detailAnalytical skillsCommunication
Certifications:RHITRHIACCSCPC
Languages:English
Tech Stack:Grouper/PricerICD-10-CMICD-10-PCSCPTHCPCSNCCI editsOPPSAPCEAPGLCDNCD

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