Apc Coding Validation Specialist

Machinifyinc

Remote, US
Remote
Expert-level icd-10-cm/pcs proficiency
Apc and opps reimbursement knowledge
Ncci edits and modifier usage expertise
Machinifyinc is seeking a remote Apc Coding Validation Specialist to conduct comprehensive outpatient payment validation reviews, ensuring compliance and accuracy in coding and billing. The ideal candidate will have expertise in coding guidelines, outpatient reimbursement methodologies, and relevant experience in auditing

Job Summary

  • This role involves performing comprehensive outpatient payment validation reviews to ensure accurate and compliant payment determinations.
  • The specialist must apply expert-level knowledge of coding guidelines including CPT, HCPCS, and Medicare regulations like OPPS and APCs.
  • Candidates are expected to produce clear, defensible audit findings that accurately articulate reimbursement impact based on industry standards.

Matching Summary

Match Score: 85

Machinifyinc is seeking a remote Apc Coding Validation Specialist to conduct comprehensive outpatient payment validation reviews, ensuring compliance and accuracy in coding and billing. The ideal candidate will have expertise in coding guidelines, outpatient reimbursement methodologies, and relevant experience in auditing.

Skills & Requirements

Must-have

  • Expert-level ICD-10-CM/PCS proficiency
  • APC and OPPS reimbursement knowledge
  • NCCI edits and modifier usage expertise
  • Medicare LCDs and NCDs interpretation
  • Outpatient facility auditing experience

Nice-to-have

  • Strong written communication skills
  • Experience with Interventional Radiology
  • Ability to work independently
  • Knowledge of radiation oncology services

Key Requirements

  • Associate's or Bachelor's degree in Health Information Management
  • Active certification: RHIT, RHIA, CCS, or CPC
  • 5-7 years of outpatient facility coding/auditing experience
  • At least 2 years of pre-pay/post-pay reimbursement audits

Work Rights

Not specified

Tailored Resume

Cover Letter