Coding Validation Specialist (Behavioral Health / Substance Use Disorder)
New
M
MachinifyHealthcare Intelligence
Remote - USFull-TimeMiddle
Salary90,000 - 100,000 USD per year
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Job Details
- Experience
- Minimum of three years of experience in coding or auditing behavioral health and/or SUD claims.
- Required Skills
- Microsoft Office
Requirements
- High School Diploma or equivalent GED.
- Active, unrestricted nursing license (RN or LPN/LVN) OR national coding certification (RHIA, RHIT, CPC, or CCS).
- Minimum of 3 years of experience in coding or auditing behavioral health and/or SUD claims.
- Working knowledge of DSM-5 diagnostic coding applied to ICD-10-CM.
- Comprehensive knowledge of APC structure and regulatory requirements for behavioral health and SUD services.
- Understanding of behavioral health/SUD documentation requirements, including treatment plans and progress notes.
- Familiarity with 42 CFR Part 2 confidentiality and mental health parity (MHPAEA) considerations.
- Proficiency with computer applications, Grouper/Pricer software, and Microsoft Office products.
- Strong analytic, critical thinking, and communication skills.
- Ability to work independently and within a team environment.
Responsibilities
- Perform comprehensive analysis of claim information and medical records to validate billed procedure and service codes.
- Maintain expert knowledge of CPT, HCPCS Level II, ICD-10-CM, and DSM-5 coding conventions for behavioral health and SUD services.
- Analyze and resolve coding issues related to reimbursement, compliance, and client-specific policies.
- Validate patient data against treatment plans, progress notes, and level-of-care documentation.
- Apply appropriate rationales for coding changes, citing official guidelines and manuals.
- Monitor claim characteristics impacting reimbursement, including revenue code and procedure code pairing.
- Maintain quality and production standards for the identification and correction of coding errors.
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