What are the responsibilities and job description for the APC Coding Validation Specialist position at The Rawlings Group?
Job Details
APC Coding Validation Specialist
Who we Are
As a leading healthcare intelligence company with over 40 years of experience, we put our unrivaled payment integrity, subrogation, and coordination of benefits (COB) expertise, expansive perspective, and relentless focus to work for our clients—ensuring no stone is left unturned in our pursuit of unmatched results. Our commitment to accuracy and excellence has helped us grow into a proven leader of our industry, relied on by companies large and small to help them maximize their return on investment.
Location: This role is full remote
About the Opportunity
At NewCo, we’re constantly reimagining what’s possible in our industry—creating disruptively simple, powerfully clear ways to maximize our clients’ financial outcomes today and drive down healthcare costs tomorrow. As part of the Complex Payment Solutions Team, as an APC Coding Validation Specialist, you will independently manage case reviews, validations, and reporting, ensuring efficiency, quality, and alignment with the company’s mission. You will hold credentials such as, Certified Coding Specialists (CCS) with AHIMA, Certified Professional Coders (CPC) with AAPC, or Registered Radiation Oncology Coders (ROCC) and use your expertise, focus, and commitment to service excellence ensure the best outcomes for our clients.
What you’ll do
- Maintain a client-focused approach in all tasks.
- Conduct APC audits with 95% accuracy, contributing to overall recovery goals.
- Document audit findings accurately and effectively.
- Complete audits within assigned deadlines.
- Provide regular progress updates to the Manager, including detailed status reports.
- Actively collaborate as a member of the VARIS Service Team.
- Adhere to internal standards across all job responsibilities.
- Exhibit initiative and strong team-building skills.
- Attend departmental meetings as needed.
- Stay informed on coding changes and updates.
- Communicate professionally with clients, facilities, and staff.
What experience you bring (Role Requirements)
Certifications: (minimum of 1 of the following coding credentials required)
- Registered Health Information Administrator (RHIA),
- Registered Health Information Technician (RHIT),
- Certified Coding Specialist (CCS), CCS-P AHIMA
- Certified coding professional (CPC) AAPC
- Certified Interventional Radiology Cardiovascular Coder (CIRCC) AAPC
- Registered Radiation Oncology Coder (ROCC)
- Minimum 5 years of hospital outpatient/ambulatory coding experience, specializing in OPPS, APC, or related billing and reimbursement rules, or at least 4 years in OPPS/APC case validation.
- Strong oral and written communication skills.
- Extensive knowledge of APC/OPPS grouping, payment structures, and regulatory requirements.
- Proficient in complex outpatient medical record reviews to validate claim codes and APC/OPPS payments, including audits for compliance in areas such as ED CPT leveling, professional/facility fees, substance abuse, and mental health services (based on client scope).
- Expert understanding of coding conventions and guidelines, including Official Coding Guidelines, AHA Coding Clinic, CPT Assistant (AMA), and other relevant coding resources (e.g., radiation oncology).
- Skilled in using APC Grouper/Pricer software, coding encoders, and related computer applications.
- Willing to travel for annual training events.
- Adheres to AHIMA Standards of Ethical Coding.
- Must meet or exceed acceptable active time on system expectations during set business hours within the employee's time zone.
What Success Looks Like…
After 3 months
- You will have a strong understanding of the role.
- You begin building relationships and collaborating with peers.
- You develop effective time and priorities management.
- You receive initial feedback about your performance and are using it to improve.
- You’ve gained confidence in your abilities and are starting to feel more comfortable in your role.
After 1 year
- You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency.
- You have established a strong network of internal relationships and are recognized as a key collaborator.
- You’ve been entrusted with greater responsibility indicating the company’s confidence in your abilities.
- You see opportunities for career progression and personal development.
Pay range: $80,000-$95,000 USD
This is an exempt position. The salary range is for Base Salary. Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee’s geographic location.
What’s in it for you
- PTO, Paid Holidays, and Volunteer Days
- Eligibility for health, vision, and dental coverage, 401(k) plan participation with company match, and flexible spending accounts.
- Tuition Reimbursement
- Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
- Remote and hybrid work options
At NewCo, we’re reimagining a simpler way forward. This begins with our employees. We are innovators who value integrity, teamwork, accuracy, and flexibility. We do the right thing, and we listen to the needs of our clients and their members. As tenured experts with unmatched experience, we champion diverse perspectives that help us to better understand and serve our clients.
Our values come to life through our culture. We embrace flexible working arrangements that allow our employees to bring innovation to life in the way that best suits their productivity. We work cross-functionally, abandoning silos, to bring innovative, accurate solutions to market. We invest in each other through ongoing education and team celebrations, and we give back to our communities through dedicating days for volunteering. Together, NewCo is making healthcare work better for everyone, and we’re passionate about a future with better outcomes for all.
We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. NewCo is an employment at will employer.
#INDHP
#LI-VPM
Salary : $80,000 - $95,000
