Certified Coding Validation Specialist

Job Summary

As a Coding Validation Specialist on the Complex Payment Solutions Team, this remote position will conduct comprehensive outpatient payment validation reviews, ensuring accurate coding and compliance with reimbursement methodologies and regulatory requirements.

Key responsibilities:

• Conduct comprehensive reviews to validate billed charges against medical documentation and payer policies
• Apply coding guidelines across various outpatient services, including Interventional Radiology and outpatient surgeries
• Produce clear audit findings and develop rationales for coding changes impacting reimbursement

Required qualifications:

• Associate's or Bachelor's degree in Health Information Management, Medical Coding, or a related field
• At least 2 years of experience in pre-pay and/or post-pay reimbursement audits
• Active certification such as RHIT, RHIA, CCS (AHIMA), or CPC
• 5-7 years of experience in outpatient facility coding/auditing
• Expertise in Medicare regulations and outpatient reimbursement methodologies