Coding Validation Specialist (Behavioral Health / Substance Use Disorder) in New York at Jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Coding Validation Specialist (Behavioral Health / Substance Use Disorder) based in United States.

This is a specialized healthcare coding and claims validation role focused on ensuring behavioral health and substance use disorder services are accurately documented, coded, and reimbursed.
You will review medical records and claims across outpatient facility and professional settings, applying advanced coding and regulatory knowledge.
The role combines clinical or coding expertise with analytical investigation, quality assurance, and detailed documentation.
You will evaluate complex coding scenarios involving psychiatric services, psychotherapy, SUD treatment, MAT, OTP, IOP, PHP, and other behavioral health services.
Your work will directly support accurate payments, regulatory compliance, and improved financial outcomes for healthcare organizations.
You will operate independently in a production-focused environment while collaborating with internal teams and applying evolving technology and AI-powered tools.
This opportunity is well suited to an experienced behavioral health coder or licensed nurse seeking a specialized, impact-oriented remote role.

• Perform comprehensive reviews of claims and supporting medical records to validate billed procedure and service codes for behavioral health and substance use disorder services.
• Apply expert knowledge of CPT, HCPCS Level II, ICD-10-CM, DSM-5-based diagnosis coding, and applicable Official Coding Guidelines to identify inaccurate or unsupported coding.
• Review documentation such as treatment plans, progress notes, authorizations, and level-of-care records to validate patient information and billed services.
• Analyze and resolve coding issues affecting reimbursement, compliance, and client-specific requirements, including revenue-code and CPT/HCPCS code pairing.
• Develop clear rationales for coding changes that may affect APC or EAPG assignments, supporting conclusions with relevant coding guidelines, billing manuals, regulatory references, and ASAM criteria where applicable.
• Remain current on behavioral health and SUD coding rules, regulatory changes, industry developments, and best practices, including requirements related to psychiatric services, psychotherapy, MAT, OTP, IOP, PHP, and ABA.
• Apply knowledge of 42 CFR Part 2 confidentiality requirements and mental health parity considerations when reviewing and documenting sensitive behavioral health and SUD information.
• Maintain established accuracy, quality, and productivity standards while documenting review findings and outcomes thoroughly.
• Use relevant technology and applications, including Grouper/Pricer software, ICD-10-CM encoder tools, Microsoft Office, and AI-powered search solutions.
• Follow professional ethical coding standards and maintain appropriate confidentiality when handling protected health and client information.

• High school diploma or GED required.
• An active, unrestricted RN or LPN/LVN nursing license in good standing, or a national coding certification such as RHIA, RHIT, CPC, or CCS.
• At least 3 years of experience coding or auditing behavioral health and/or substance use disorder claims.
• Strong working knowledge of DSM-5 diagnostic coding as applied to ICD-10-CM and behavioral health/SUD documentation requirements.
• Comprehensive understanding of APC structures and regulatory requirements applicable to behavioral health and substance use disorder services.
• Experience reviewing treatment plans, progress notes, authorization requirements, and level-of-care documentation.
• Strong analytical, critical-thinking, and problem-solving skills, with the ability to investigate complex coding and reimbursement issues.
• Excellent written and verbal communication skills and the ability to clearly document findings and coding rationales.
• Ability to work independently while also contributing effectively to a collaborative, production-oriented team.
• Comfort using AI-powered search tools and enthusiasm for learning new technologies and workflows.
• Preferred: Associate or bachelor's degree in health information management, nursing, medical coding, or a related discipline.
• Preferred: Certified Behavioral Health Coding Specialist (CBHCS) or equivalent behavioral health coding credential.
• Preferred: Experience with post-adjudication, pre-pay, or post-payment claim validation, EAPG claims, MAT, OTP, IOP/PHP, ABA, MHPAEA, or managed behavioral health billing structures.

• Remote-first position: Work from anywhere in the United States.
• Competitive salary with a stated pay range of $90,000–$100,000, depending on experience, skills, certifications, and other role-related factors.
• Medical, dental, and vision insurance options.
• Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
• 401(k) plan with company match.
• Tuition reimbursement.
• Additional health and wellness benefits and perks.
• Flexible and trusting work environment designed to empower employees to perform at their best.