Certified Coding Specialist

Job Summary

Reviewing completed outpatient coding validation audits, the remote Quality Validation Specialist will ensure accuracy, compliance, and adherence to standards while providing feedback and supporting continuous improvement initiatives.

Key responsibilities

• Performs secondary reviews of outpatient coding audits to verify accuracy and compliance with coding guidelines and payer policies
• Evaluates auditor performance and provides constructive feedback to promote consistency and accuracy in coding practices
• Collaborates with leadership to enhance audit methodologies and supports continuous quality improvement initiatives

Required qualifications

• Associate's or Bachelor's degree in Health Information Management, Healthcare Administration, or a related field preferred
• Current certification through AHIMA and/or AAPC, including CCS (Certified Coding Specialist)
• Minimum of 5 years of hospital outpatient coding experience or outpatient/APC validation auditing experience
• Extensive knowledge of CPT, HCPCS Level II, ICD-10-CM, and outpatient reimbursement methodologies
• Experience using industry-standard encoder and auditing tools such as Optum, TrueBridge, and/or 3M