Machinify

Quality Validation Specialist

Remote - US · Mid

Sponsorship not specifiedDetected 42 days ago

AuditingICD-10RadiologyLeadershipCommunicationProblem SolvingCritical ThinkingMentoringInternal Audit

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.

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.

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.

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.

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.

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.

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.
equal opportunity workplace.

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

This listing is sourced directly from Machinify's careers page and normalized into a canonical job model.