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Role Description

At Machinify, we’re constantly reimagining what’s possible in our industry—creating disruptively simple, powerfully clear ways to maximize our clients’ financial outcomes today and drive down healthcare costs tomorrow. As part of the Complex Payment Solutions team, you will, as an APC Coding Validation Specialist, review provider medical records to validate accuracy of billed Ambulatory Payment Classification (APC) and/or Enhanced Ambulatory Patient Group (EAPG).

• Review medical records to ensure the accuracy of coding, billing, and documentation related to APCs, EAPGs, CPT, and HCPCS Level II codes.
• Report findings and communicate results.
• Ensure compliance with regulatory and client requirements.
• Maintain quality and productivity standards.

Qualifications

• High School Diploma or Equivalent GED.
• National certification as Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Procedural Coder (CPC) and/or Certified Coding Specialist (CCS).
• Minimum of five years hospital outpatient coding for PPS reimbursement or at least 2 years’ experience performing APC validation.
• Comprehensive knowledge of the APC structure and regulatory requirements.
• Excellent oral and written communication skills.
• Strong analytic and critical thinking skills.
• Able to work independently as well as part of a team in a production environment.

Requirements

• Perform comprehensive analysis and review of claim information and associated medical records to validate the billed procedure and service codes.
• Maintain expert knowledge of CPT and HCPCS level II coding conventions and rules, Official Coding Guidelines, and American Medical Association (AMA) Coding Clinic.
• Analyze, review, and resolve coding issues related to reimbursement, compliance, and client specific policies.
• Validate patient data by comparing claims data received with the patient medical records.
• Develop and/or apply the appropriate rationale for any coding change that affects the coding or the APC or EAPG assignment.
• Analyze claim and supporting documentation for all claim characteristics impacting reimbursement.
• Maintain accuracy, quality, and production standards set by management and clients.
• Ability to use computer applications, Grouper/Pricer software, ICD-10-CM encoder software, and Microsoft Office products.
• Abide by the Standards of Ethical Coding as set forth by the American Health Information Management Association.

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.
• Pay range: $85,000 - $95,000, with the opportunity to earn quarterly bonuses.