The Rawlings Group
APC Coding Validation Specialist
What's your preference?
Job Description
- Req#: 296802
Employer Industry: Healthcare Intelligence
Why consider this job opportunity:
- Salary up to $100,000
- PTO, paid holidays, and volunteer days
- Eligibility for health, vision, and dental coverage, along with 401(k) plan participation with company match
- Remote and hybrid work options available
- Opportunity for career progression and personal development within the organization
What to Expect (Job Responsibilities):
- Perform comprehensive analysis and review of claim information and associated medical records to validate the accuracy of billed procedure and service codes
- Maintain expert knowledge of CPT and HCPCS Level II coding conventions, Official Coding Guidelines, and ICD-10 diagnosis coding
- Analyze, review, and resolve coding issues related to reimbursement, compliance, and client-specific policies
- Validate patient data by comparing claims data with medical records
- Maintain accuracy, quality, and production standards set by management and clients
What is Required (Qualifications):
- High School Diploma or Equivalent GED
- National certification as Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Procedural Coder (CPC), and/or Certified Coding Specialist (CCS)
- Minimum of five years of hospital outpatient coding for PPS reimbursement or at least two years of experience performing APC validation
- Comprehensive knowledge of the APC structure and regulatory requirements
- Excellent oral and written communication skills
How to Stand Out (Preferred Qualifications):
- Associate or Bachelor's degree in health information management, medical coding, or a related field
- At least two years performing post-adjudication/pre-pay or post-payment APC validation
- Well-rounded APC experience, including specialty coding such as interventional radiology, infusions, and surgeries
- Experience coding or reviewing EAPG claims
#HealthcareIntelligence #CodingValidation #RemoteWork #CareerGrowth #HealthInsurance
We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
The Rawlings Group has an unbeaten record of recovering more money for more health plans than any other vendor. Contact us today.
Notice
Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at accessibility@talentify.io or 407-000-0000.
Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.
An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report. NYC applicants may request an alternative process or accommodation at aedt@talentify.io or 407-000-0000.