Coding Validation Specialist, Behavioral Health, Substance Use Disorder

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluate and assess claim information along with medical records to confirm the validity of behavioral health and SUD procedure and service codes.

• Maintain in-depth knowledge of CPT, HCPCS Level II, DSM-5/ICD-10-CM, Official Coding Guidelines, and the coding regulations specific to behavioral health/SUD.

• Examine, assess, and rectify coding discrepancies related to reimbursement, compliance, and policies specific to clients.

• Verify patient information against treatment plans, progress notes, and documentation of level-of-care.

• Formulate and implement justifications for coding modifications impacting APC or EAPG assignments, including reference citations.

• Review claim documentation along with revenue-code/CPT-HCPCS combinations that influence reimbursement.

• Ensure precision, quality, and production benchmarks while documenting review outcomes.

• Implement 42 CFR Part 2 confidentiality and MHPAEA considerations.

• Utilize computer applications, Grouper/Pricer software, ICD-10-CM encoder software, and Microsoft Office tools.

• Adhere to AHIMA Standards of Ethical Coding.

⛳️ Requirements

• High School Diploma or equivalent GED.

• One of the following: an active, unrestricted nursing license (RN or LPN/LVN) in good standing, or a national coding certification such as RHIA, RHIT, CPC, or CCS.

• A minimum of three years of experience in coding or auditing claims related to behavioral health and/or SUD.

• Proficient knowledge of DSM-5 diagnostic coding as it relates to ICD-10-CM, along with behavioral health/SUD documentation criteria.

• Extensive understanding of the APC structure and the regulatory requirements relevant to behavioral health and SUD services.

• Comfort with AI-driven search tools and a willingness to embrace new technologies.

• Exceptional oral and written communication abilities.

• Strong analytical and critical thinking capabilities.

• Capacity to work autonomously as well as collaboratively in a production-focused environment.

🏝️ Benefits

• Work from anywhere in the US! Machinify operates on a digital-first model.

• Comprehensive Medical/Dental/Vision coverage.

• Flexible Spending Account/Health Savings Account options.

• Tuition reimbursement program.

• Competitive salary structure.

• 401(k) plan with company matching contributions.

• Additional health and wellness benefits along with various perks.

• A flexible and trusting atmosphere where you’ll be empowered to perform at your best.