Manager, Medical Review Coding — Behavioral Health

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.

The Manager, Medical Review Coding — Behavioral Health leverages deep expertise in Behavioral Health Coding and the related payment integrity landscape to own operational results for a remote team of coders and audit roles performing behavioral health coding audits. The Manager is accountable for audit quality, team performance, segment strategy, and serves as the organization's subject matter expert across behavioral health CPT coding, DSM-5-based diagnostic coding, and applicable payer and regulatory requirements. Responsible for driving strategy activities including needs assessments, capacity planning, staffing models, cost/benefit analysis, and establishing productivity and quality standards specific to behavioral health audit operations.

Key Responsibilities:

• Provides operational oversight of the outpatient behavioral health coding audit team; serves as the primary subject matter expert for behavioral health coding including psychiatric and psychological services, substance use disorder treatment, ABA, H-codes, and HCPCS Level II behavioral health codes.
• Leads development, maintenance, and refinement of behavioral health review guidelines and audit concepts, ensuring alignment with CMS, Medicaid, and commercial payer policies; monitors and interprets regulatory and policy changes including DSM-5 updates, coverage expansions, Medicaid carve-out requirements, and parity regulations.
• Partners with clinical leadership, audit management, segment specialists, and adjacent QA and appeals teams to implement new clients and concepts, align on escalations, and drive continuous improvement in behavioral health audit workflows.
• Proactively identifies opportunities for cost savings, revenue protection, and outcome improvement; uses data and clinical expertise to identify capacity gaps, backlogs, and performance risks and align resources to meet SLAs and business objectives.
• Manages daily activities of coding audit staff; provides behavioral health-specific guidance, trend identification, coaching, and constructive feedback to drive performance and quality outcomes.
• Oversees staffing levels, time and attendance, performance reviews, and corrective action in collaboration with HR and senior management.
• Provides operational and performance reporting to senior management; participates in department and client-facing meetings and presents behavioral health coding findings, solutions, and provider education as needed.
• Leads development of training materials and best practices; ensures all audit staff are equipped with current tools, resources, and training to perform behavioral health coding audits accurately and efficiently.
• Maintains current knowledge of behavioral health industry changes including regulations, payer policy, and business trends; fosters a team environment built on open communication, continuous improvement, and high performance.
• Performs other duties as required and assigned to meet business needs.

Knowledge, Skills, and Abilities Needed:

• Expert knowledge of outpatient behavioral health coding including psychiatric E/M, psychotherapy, neuropsychological testing, substance use disorder treatment, ABA therapy, and crisis intervention CPT codes across professional and facility settings.
• In-depth knowledge of DSM-5 diagnostic coding as applied to ICD-10-CM, and medical documentation requirements for behavioral health services including treatment plans, progress notes, provider credential requirements, and authorization standards.
• Strong knowledge of CPT, HCPCS Level II, ICD