Quality Validation Specialist (Healthcare)

TL;DR

Quality Validation Specialist (Healthcare): Reviewing outpatient coding validation audits to ensure accuracy, compliance, and adherence to regulatory standards with an accent on APC, CPT, and ICD-10-CM coding methodologies. Focus on identifying trends, providing auditor feedback, and supporting continuous quality improvement initiatives within a healthcare intelligence platform.

Location: Must be based in the US

Salary: $105,000 base salary

Company

hirify.global is a healthcare intelligence company providing an AI-powered platform to health plans to maximize financial outcomes and drive down healthcare costs.

What you will do

• Perform secondary reviews of outpatient coding audits to verify accuracy and compliance with official guidelines and payer policies.
• Evaluate auditor performance against quality benchmarks and provide constructive feedback and coaching.
• Develop and maintain quality assurance tools, scorecards, and audit tracking mechanisms.
• Collaborate with leadership to standardize audit methodologies and clarify coding guidance.
• Monitor and report QA metrics, quality trends, and corrective action plans.
• Assist in the development of training materials based on identified trends and regulatory updates.

Requirements

• Must be based in the US
• Current AHIMA or AAPC certification (RHIA, CCS, or CPC) required.
• Minimum 5 years of hospital outpatient coding experience or outpatient/APC validation auditing experience.
• Extensive knowledge of CPT, HCPCS Level II, ICD-10-CM, and Medicare OPPS reimbursement methodologies.
• Proficiency with industry-standard encoder and auditing tools like Optum, TrueBridge, or 3M.
• Strong analytical and communication skills with the ability to provide professional feedback.

Nice to have

• 5–7 years of experience in pre-pay, post-pay, or post-adjudication outpatient validation reviews.
• Experience with EAPG claims.
• Prior experience in auditor mentoring, training, or team leadership.
• Experience auditing complex claims such as radiation oncology, interventional radiology, or behavioral health.

Culture & Benefits

• Comprehensive health, vision, and dental coverage.
• 401(k) plan participation with company match.
• Paid Time Off, holidays, and volunteer days.
• Tuition reimbursement program.
• Company-paid life insurance, short-term disability, and parental leave.
• Flexible remote and hybrid work options.