APC Coding Validation Specialist (Healthcare)

TL;DR

APC Coding Validation Specialist (Healthcare): Performing comprehensive outpatient payment validation reviews with an accent on coding guidelines, reimbursement methodologies, and regulatory compliance. Focus on validating medical records against APC, EAPG, and CPT codes to ensure accurate reimbursement and compliance.

Location: Remote (Must be based in the US)

Salary: $85,000 - $100,000

Company

An AI-powered healthcare intelligence company providing payment continuum expertise to maximize financial outcomes for health plans.

What you will do

• Conduct comprehensive reviews of billed charges against medical documentation, payer policies, and industry standards.
• Apply coding guidelines for specialized outpatient services including Interventional Radiology, Radiation Oncology, and outpatient surgeries.
• Utilize expert knowledge of Medicare OPPS, APC, and EAPG reimbursement methodologies.
• Interpret and apply Medicare Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), and NCCI edits.
• Produce clear, defensible audit findings and rationales citing AMA and AHA official guidelines.
• Maintain quality and productivity standards using Grouper/Pricer software and ICD-10 encoders.

Requirements

• Must be based in the US.
• Associate’s or Bachelor’s degree in Health Information Management, Medical Coding, or a related field.
• 5-7 years of experience in outpatient facility coding or auditing.
• At least 2 years of experience performing pre-pay and/or post-pay reimbursement audits.
• Active certification including RHIT, RHIA, CCS (AHIMA), and/or CPC.
• Expertise in ICD-10-CM/PCS, CPT, HCPCS, and OPPS/APC methodologies.

Culture & Benefits

• Digital-first environment allowing work from anywhere in the US.
• Comprehensive Medical, Dental, and Vision insurance offerings.
• 401(k) plan with company match.
• FSA, HSA, and tuition reimbursement.
• Flexible and trusting work culture that empowers employees.