Coding Validation Specialist (Behavioral Health / Substance Use Disorder)
New
J
JobgetherBehavioral Healthcare
Work from anywhere in the United States.Full-TimeMiddle
Salary90,000 - 100,000 USD per year
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Job Details
- Experience
- At least 3 years
Requirements
- High school diploma or GED.
- Active, unrestricted RN or LPN/LVN nursing license, or a national coding certification (RHIA, RHIT, CPC, or CCS).
- At least 3 years of experience coding or auditing behavioral health and/or substance use disorder claims.
- Strong working knowledge of DSM-5 diagnostic coding applied to ICD-10-CM and documentation requirements.
- Comprehensive understanding of APC structures and regulatory requirements for behavioral health and SUD services.
- Experience reviewing treatment plans, progress notes, authorization requirements, and level-of-care documentation.
- Strong analytical, critical-thinking, and problem-solving skills.
- Excellent written and verbal communication skills.
- Ability to work independently in a production-oriented team.
- Comfort using AI-powered search tools and learning new technologies.
Responsibilities
- Perform comprehensive reviews of claims and supporting medical records to validate billed procedure and service codes for behavioral health and substance use disorder services.
- Apply expert knowledge of CPT, HCPCS Level II, ICD-10-CM, DSM-5-based diagnosis coding, and Official Coding Guidelines.
- Review treatment plans, progress notes, authorizations, and level-of-care records to validate patient information.
- Analyze and resolve coding issues affecting reimbursement, compliance, and client-specific requirements.
- Develop clear rationales for coding changes, supporting conclusions with relevant coding guidelines, billing manuals, and ASAM criteria.
- Maintain established accuracy, quality, and productivity standards while documenting review findings.
- Utilize technology including Grouper/Pricer software, ICD-10-CM encoder tools, and AI-powered search solutions.
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