Manager, Medical Review Coding — Behavioral Health

TL;DR

Manager, Medical Review Coding — Behavioral Health (Medical Coding/Audit): Own operational results for a remote team performing outpatient behavioral health coding audits, with an accent on audit quality, segment strategy, and behavioral health CPT/DSM-5 diagnostic coding decisions. Focus on building and maintaining behavioral health review guidelines aligned to CMS/Medicaid/commercial payer policies, driving capacity planning and productivity/quality standards, and using data to protect revenue and improve outcomes.

Company

hirify.global is a healthcare intelligence company providing an AI-powered platform and expertise for health plan payment integrity.

What you will do

• Provide operational oversight for the outpatient behavioral health coding audit team and act as the primary subject matter expert for psychiatric/psychological services, SUD treatment, ABA, H-codes, and HCPCS Level II behavioral health codes.
• Develop, maintain, and refine behavioral health review guidelines and audit concepts aligned with CMS, Medicaid, and commercial payer policies; monitor DSM-5 updates and payer/regulatory changes.
• Partner with clinical leadership, audit management, segment specialists, and adjacent QA/appeals teams to implement new clients/concepts and drive continuous improvement in audit workflows.
• Identify cost savings, revenue protection, and outcome improvement opportunities by analyzing capacity gaps, backlogs, and performance risks to meet SLAs.
• Manage daily activities of coding audit staff, including behavioral health-specific guidance, coaching, feedback, staffing/time & attendance, performance reviews, and corrective actions.
• Produce operational/performance reporting for senior management and lead training material development and best practices for accurate, efficient audits.

Requirements

• Location: Work from anywhere in the US
• Current certification as a CPC, CPC-P, RHIA, RHIT, or CCS (required); CPMA strongly preferred.
• Strong behavioral health coding expertise for outpatient settings, including psychiatric E/M, psychotherapy, neuropsychological testing, SUD treatment, ABA therapy, and crisis intervention CPT codes.
• In-depth DSM-5 diagnostic coding knowledge as applied to ICD-10-CM, plus behavioral health documentation requirements (treatment plans, progress notes, provider credentialing, authorization standards).
• Proficiency with CPT, HCPCS Level II, ICD-10-CM, and payer coverage/payment rules (CMS/Medicaid/commercial), including mental health parity requirements.
• Ability to lead and hold accountable a high-performing remote team; must complete a Teleworker Agreement and maintain HIPAA/confidentiality compliance with appropriate workspace and high-speed internet.

Culture & Benefits

• Work from anywhere in the US; digital-first environment.
• Top Medical/Dental/Vision coverage.
• FSA/HSA options.
• Tuition reimbursement.
• Competitive salary with 401(k) match and annual bonus; additional health and wellness benefits.
• Flexible, trusting environment focused on empowerment and continuous improvement.

Hiring process

• Recruiting team will confirm eligibility for the appropriate level/range based on experience, skills, and certifications.
• Interviews and evaluation of behavioral health coding/audit expertise and leadership capability.