Machinify

Machinify

Quality Validation Specialist, Outpatient Coding

Remote - US · Senior

Sponsorship not specifiedDetected 2 days ago
AuditingICD-10RadiologyLeadershipCommunicationProblem SolvingCritical ThinkingMentoringInternal Audit

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odds of building a lasting career here

40Risky
Cap-exempt (no lottery)0
Sponsors this role90
Entry-level history0
PERM / green-card track0
Lottery odds40
Fits your clock70

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Files H-1B transfers

17 transfer filings in the last year, covering 17 workers. Median labor-condition decision: 7 days. An employer that already files transfers is one that can take over an existing H-1B.

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About the role

  • Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country.
  • About the Opportunity The Quality Validation Specialist reviews completed outpatient coding validation audits to ensure accuracy, consistency, compliance, and adherence to client, regulatory, and organizational standards.
  • This role evaluates audit quality related to APCs, EAPGs, CPT, HCPCS Level II, and ICD-10-CM coding while supporting continuous improvement initiatives across the validation process.

Responsibilities

  • 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.
  • Validates accurate assignment and review of CPT, HCPCS Level II, and ICD-10-CM codes, including appropriate use of modifiers and supporting references such as Official Coding Guidelines, CMS regulations, AMA guidance, LCDs, and NCDs.
  • Develops and maintains QA tools, scorecards, and documentation standards to support objective review processes.
  • Performs secondary reviews across multiple audit and coding platforms while maintaining established productivity and quality expectations.
  • Performs other duties as assigned.

Requirements

  • Extensive knowledge of CPT, HCPCS Level II, ICD-10-CM, NCCI edits, and appropriate modifier usage.
  • Proficiency interpreting and applying Medicare LCD and NCD guidelines.
  • Experience using industry-standard encoder and auditing tools such as Optum, TrueBridge, and/or 3M.
  • Ability to work independently and collaboratively in a fast-paced production and quality-driven environment.
  • Current certification through AHIMA and/or AAPC required, including one or more of the following:
  • We participate in E-Verify as required by applicable law.

Nice to have

  • Advanced experience auditing or coding complex outpatient facility claims, including but not limited to:
  • Interventional Radiology
  • Radiation Oncology
  • Ambulatory Surgery
  • Cardiac Catheterization
  • Injections and Infusions
  • Emergency Department - including ED E&M Leveling
  • Experience coding, auditing, or validating Enhanced Ambulatory Patient Grouping (EAPG) claims.

Compensation

  • This is an exempt position starting at $105,000 with bonus opportunity.
  • The salary range is for Base Salary. Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee's geographic location.
  • In accordance with applicable state laws, we do not inquire about salary history during the recruitment process.

Benefits

  • PTO, Paid Holidays, and Volunteer Days
  • Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
  • Tuition Reimbursement
  • Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.

Company info

  • We are proud to be an equal opportunity workplace.
  • If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know.
  • We are proud to be an

Equal opportunity

  • equal opportunity workplace.

Visa & Work Authorization

  • al employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status
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This listing is sourced directly from Machinify's careers page and normalized into a canonical job model.