Coding Validation Specialist (Behavioral Health / Substance Use Disorder)

Machinify
United States
Workplace: RemoteFull timeUSD 90,000 - 100,000 annuallyFunction: Administration & Executive AssistanceExperience: 3+ yearsEducation: high_schoolSkills: ["Communication","Analytic thinking","Critical thinking","Independence","Teamwork"]

Review outpatient facility and professional behavioral health/SUD claims by auditing medical records to validate billed codes and documentation accuracy. Apply expert CPT/HCPCS Level II, DSM-5/ICD-10-CM diagnosis coding, and coding guidelines to resolve reimbursement and compliance issues, including APC/EAPG impacts and coverage policy requirements. Use Grouper/Pricer and encoder tools to maintain quality and production standards while following 42 CFR Part 2 confidentiality and mental health parity considerations.

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Machinify
Machinify
1 day ago

Coding Validation Specialist (Behavioral Health / Substance Use Disorder)

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Source: Company careers pageValidated by: Fursa AI
Last checked: 12 hours agoStatus: Live

Job Summary

Review outpatient facility and professional behavioral health/SUD claims by auditing medical records to validate billed codes and documentation accuracy. Apply expert CPT/HCPCS Level II, DSM-5/ICD-10-CM diagnosis coding, and coding guidelines to resolve reimbursement and compliance issues, including APC/EAPG impacts and coverage policy requirements. Use Grouper/Pricer and encoder tools to maintain quality and production standards while following 42 CFR Part 2 confidentiality and mental health parity considerations.
Location: United States
Workplace: Remote
Employment Type: Full time
Job Function: Administration & Executive Assistance
Seniority: Mid level

Key Responsibilities

  • •Perform comprehensive analysis of claims and medical records to validate accurate billed procedure/service codes for behavioral health and/or SUD services.
  • •Apply expert knowledge of CPT/HCPCS Level II conventions and rules for behavioral health and SUD, including psychiatric evaluation and management, psychotherapy, and MAT/OTP and levels of care.
  • •Analyze, review, and resolve coding issues affecting reimbursement, compliance, and client-specific behavioral health/SUD policies.
  • •Compare claims data to patient records (treatment plans, progress notes, and level-of-care documentation) to validate the accuracy of billed services.
  • •Maintain quality and production standards, documenting coding outcomes while following 42 CFR Part 2 confidentiality and MHPAEA considerations.

Pay and Benefits

Salary: USD 90,000 - 100,000 annually
Perks:Health InsuranceDentalVisionFsa/hsa401k

Key Requirements

  • •High school diploma or equivalent GED.
  • •Active, unrestricted nursing license (RN or LPN/LVN) in good standing OR a national coding certification (RHIA, RHIT, CPC, or CCS).
  • •Minimum three years of experience 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.
Experience:3+ yearsHealthcareBehavioral healthSubstance use disorderClaims auditingOutpatient codingReimbursement compliance
Education:High School
Skills:CommunicationAnalytic thinkingCritical thinkingIndependenceTeamwork
Licenses:RNLPN/LVN
Certifications:RHIARHITCPCCCSCBHCS
Languages:English
Tech Stack:CPTHCPCS Level IIDSM-5ICD-10-CMGrouper/PricerICD-10-CM encoderMicrosoft OfficeAI-powered search tools

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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