Coding Validation Specialist, Behavioral Health, Substance Use Disorder

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $90k - $100k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

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Machinify

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

💰 $10M Series A - Machinify on 2018-10

Healthcare • Consulting • Logistics

Machinify is a healthcare-focused AI platform and services company that reshapes healthcare payments and payment integrity. Its AI operating system unifies claims, medical records, contracts, and policies, and uses foundation models and task-specific agents to automate and improve coding, payment accuracy, recoveries, and cost avoidance. Machinify serves health plans (including 18 of the top 20), supports insourced, hybrid, or fully-managed deployments, and emphasizes measurable outcomes — reporting 85+ customers, 270M member lives covered, and $6B+ in annual cost avoidance and recoveries.

📋 Description

• Analyze and review claim information and medical records to validate behavioral health and SUD procedure and service codes. • Maintain expert knowledge of CPT, HCPCS Level II, DSM-5/ICD-10-CM, Official Coding Guidelines, and behavioral health/SUD coding rules. • Analyze, review, and resolve coding issues related to reimbursement, compliance, and client-specific policies. • Validate patient data against treatment plans, progress notes, and level-of-care documentation. • Develop and apply rationale for coding changes affecting APC or EAPG assignments, citing supporting references. • Analyze claim documentation and revenue-code/CPT-HCPCS pairings affecting reimbursement. • Maintain accuracy, quality, and production standards and document review outcomes. • Apply 42 CFR Part 2 confidentiality and MHPAEA considerations. • Use computer applications, Grouper/Pricer software, ICD-10-CM encoder software, and Microsoft Office. • Follow AHIMA Standards of Ethical Coding.

🎯 Requirements

• High School Diploma or equivalent GED. • One of the following: active, unrestricted nursing license (RN or LPN/LVN) in good standing, or national coding certification as RHIA, RHIT, CPC, or CCS. • Minimum of three years of experience in 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. • Comfort with AI-powered search tools and willingness to learn new technologies. • Excellent oral and written communication skills. • Strong analytic and critical thinking skills. • Ability to work independently and as part of a team in a production environment.

🏖️ Benefits

• Work from anywhere in the US! Machinify is digital-first. • Top Medical/Dental/Vision offerings • FSA/HSA • Tuition reimbursement • Competitive salary • 401(k) with company match • Additional health and wellness benefits and perks • Flexible and trusting environment where you’ll feel empowered to do your best work