Quality Validation Specialist

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs. About the Opportunity The Quality Validation Specialist reviews completed outpatient coding validation audits to ensure accuracy, consistency, compliance, and adherence to client, regulatory, and organizational standards. This role evaluates audit quality related to APCs, EAPGs, CPT, HCPCS Level II, and ICD-10-CM coding while supporting continuous improvement initiatives across the validation process. The Quality Validation Specialist identifies trends, provides actionable feedback and education, monitors auditor performance, and promotes standardized application of coding guidelines and reimbursement methodologies. This position partners closely with leadership to enhance audit quality, maintain compliance, and support operational excellence. What you’ll do Performs secondary reviews of completed outpatient coding validation audits to verify coding accuracy, supporting rational