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Coding Validation Specialist Jobs (NOW HIRING)

Machinify

APC Coding Validation Specialist

$85K - $100K/yr

As a Coding Validation Specialist on the Complex Payment Solutions Team, you will play a critical role in performing comprehensive outpatient payment validation reviews. Leveraging your expertise in ...

Machinify

APC Coding Validation Specialist

$85K - $100K/yr

As a Coding Validation Specialist on the Complex Payment Solutions Team, you will play a critical role in performing comprehensive outpatient payment validation reviews. Leveraging your expertise in ...

Machinify

Quality Validation Specialist

About the Opportunity The Quality Validation Specialist reviews completed outpatient coding validation audits to ensure accuracy, consistency, compliance, and adherence to client, regulatory, and ...

Machinify

Quality Validation Specialist

Performs secondary reviews of completed outpatient coding validation audits to verify coding accuracy, supporting rationale, and compliance with official coding guidelines, payer policies ...

SmarterDx

Clinical Coding Specialist

$75K - $105K/yr

Clinical Coding Specialist (Inpatient) Role As an Inpatient Coding Specialist at SmarterDx, you will be responsible for conducting comprehensive chart reviews and coding validation of AI diagnostic ...

SmarterDx

Clinical Coding Specialist

$75K - $105K/yr

Built by physician-data scientists and trained on clinically-validated EHR data, our clinical AI ... Clinical Coding Specialist (Inpatient) Role As an Inpatient Coding Specialist at SmarterDx, you ...

All Med Search

DRG Validation Specialist

Nashville, TN

$40 - $45/hr

Assists in ensuring HSC coding staff adherence with coding guidelines and policy * Demonstrates and applies expert level knowledge of medical coding practices and concepts * Participates on special ...

ISLAND PEER REVIEW CORP

Coding Reviewer

Jericho, NY · On-site

$65K - $70K/yr

... Coding Specialist Physician (CCS-P) required. * Technical knowledge of coding and DRG validation with CPT, HCPCS experience and ICD-10 certification required * Bachelor's degree in healthcare ...

IPRO

Coding Reviewer

Jericho, NY · On-site

... Specialist Physician (CCS-P) required. • Technical knowledge of coding and DRG validation with CPT, HCPCS experience and ICD-10 certification required. • Bachelor's degree in healthcare ...

Infinx Healthcare

Coding Specialist | Ortho

$25 - $30/hr

Experience with charge entry and coding validation * Ability to review and resolve coding-related ... If you are a dedicated and experienced Healthcare Coding Specialist ready to contribute to our ...

State of Montana

Senior Threat Validation Specialist

Helena, MT · On-site +1

$100K - $136K/yr

... Specialist and lead the team in offensive security tactics, teach efficient techniques for ... Critically evaluating and validating AI-generated code, findings, and recommendations before acting ...

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As of Sep 15, 2026, the average hourly pay for coding validation specialist in the United States is $50.45, according to ZipRecruiter salary data. Most workers in this role earn between $39.66 and $61.30 per hour, depending on experience, location, and employer.

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Infographic showing various Coding Validation Specialist job openings in the United States as of August 2026, with employment types broken down into 85% Full Time, 12% Part Time, and 3% Contract. Highlights an 81% Physical, 2% Hybrid, and 17% Remote job distribution, with an average salary of $104,945 per year, or $50.5 per hour.

APC Coding Validation Specialist

Remote

Machinify
Software Development • 11 - 50 employees
Learn more about Machinifyexternal

$85K - $100K/yr

Full-time

Medical, Dental, Vision, Retirement

Re-posted 23 days ago

Job description

About the Opportunity:

As a Coding Validation Specialist on the Complex Payment Solutions Team, you will play a critical role in performing comprehensive outpatient payment validation reviews. Leveraging your expertise in coding guidelines, outpatient reimbursement methodologies, and regulatory requirements, you will ensure accurate and compliant payment determinations.

In this role, you will review medical records to validate the accuracy of coding, billing, and supporting documentation for outpatient services, including APCs, EAPGs, CPT, and HCPCS Level II codes. You will clearly document audit findings and provide well-supported rationales, citing applicable payer policies, coding guidelines, and industry-standard references.

This position requires exceptional attention to detail, expert-level proficiency in ICD-10-CM/PCS, CPT, and HCPCS coding guidelines, and a strong understanding of outpatient reimbursement methodologies.

What you'll do:

  • Conduct comprehensive reviews to validate the accuracy of billed charges against medical documentation, payer policies, coding guidelines, and industry standards to ensure appropriate reimbursement.
  • Apply coding guidelines across a broad range of outpatient services, including but not limited to Interventional Radiology, Radiation Oncology, injections and infusions, outpatient surgeries, implants, and observation services (including carve-outs).
  • Demonstrate a strong working knowledge of outpatient reimbursement methodologies, including Medicare Outpatient Prospective Payment System (OPPS), Ambulatory Payment Classification (APC), and Enhanced Ambulatory Patient Grouping (EAPG).
  • Apply expert-level knowledge of NCCI edits, including appropriate modifier usage, as well as CPT and HCPCS coding guidelines.
  • Interpret and apply Medicare Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs).
  • Produce clear, concise, and defensible audit findings that accurately articulate reimbursement impact.
  • Develop and apply well-supported rationales for coding changes impacting reimbursement, referencing appropriate sources such as AMA Official Coding Guidelines, CPT Assistant, AHA Coding Clinic, payer policies, and other industry-standard resources.
  • Work effectively both independently and collaboratively within a production-driven environment.
  • Maintain established accuracy, quality, and productivity standards, including correct code assignment and thorough documentation of review outcomes.
  • Utilize computer applications and tools, including Grouper/Pricer software, ICD-10-CM encoders, and Microsoft Office products.
  • Adhere to the Standards of Ethical Coding as established by AHIMA.
  • Perform additional duties as assigned.

What experience you bring (Role Requirements)  

  • Associate's or Bachelor's degree in Health Information Management, Medical Coding, or a related field
  • At least 2 years of experience performing pre-pay and/or post-pay reimbursement audits
  • Broad outpatient facility auditing experience, including specialty areas such as Interventional Radiology, injections and infusions, Radiation Oncology, Behavioral Health, and ambulatory surgery
  • Active certification including RHIT, RHIA, CCS (AHIMA), and/or CPC
  • 5-7 years of experience in outpatient facility coding/auditing
  • Sound knowledge of ICD-10-PCS/CM, CPT, and HCPCs coding guidelines
  • Experience performing pre- and post-payment reimbursement audits
  • Expertise in Medicare regulations, including LCDs, NCDs, NCCI edits, OPPS, and APC methodologies
  • Demonstrated experience with APC payment methodologies, OPPS reimbursement logic, fee schedules, and payer contracts
  • Excellent verbal and written communication skills
  • Strong attention to detail and analytical skills
  • Experience with encoder and auditing tools (e.g., 3M, TrueBridge, Grouper/Pricer Software)
 
 
Pay range: $85,000 - $100,000, with the opportunity to earn quarterly bonuses. The salary for this position is based on an array of factors unique to each candidate: Such as years and depth of experience, set skills, certifications, etc.  We are hiring for different levels, and our Recruiting team will let you know if you qualify for a different role/range. 
 
 
What We Offer:
  • Work from anywhere in the US! Machinify is digital-first.
  • Top Medical/Dental/Vision offerings
  • FSA/HSA
  • Tuition reimbursement
  • Competitive salary, 401(k) with company match
  • Additional health and wellness benefits and perks
  • Flexible and trusting environment where you'll feel empowered to do your best work
 

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