Remote Revenue Integrity Coding Specialist

Guidehouse; United States; Remote; USD 59,000 - 98,000; Full time

Benefits offered by this job

Medical, Rx, Dental & Vision Insurance

401(k) Retirement Plan

Tuition Reimbursement

Paid Holidays

Job summary

Guidehouse is seeking a Revenue Integrity Coding Billing Specialist for a 100% remote role in the United States. You will support revenue cycle activities by reviewing Medicare and third-party payer accounts, applying pre-bill edits, and resolving denials.

Responsibilities include coding with ICD-10, CPT and HCPCS Level II, verifying medical necessity, and ensuring compliance with guidelines. AAPC or AHIMA certification and 5+ years of experience are required.

Qualifications

• High School Diploma; relevant experience may substitute.
• 5+ years of Revenue Integrity experience.
• AAPC or AHIMA coding certification.
• Experience in ICD-10, CPT and HCPCS Level II Coding.
• Knowledge of Medicare, Medicaid, and third-party payer UB-04 billing.

Responsibilities

• Resolve assigned claims with pre-bill edits and hold codes in the hospital scrubber.
• Apply standard billing edits: CCI, MUE, Medical Necessity.
• Review clinical documentation to validate ICD-10, CPT, HCPCS codes and modifiers.
• Resolve denials in Guidehouse METRIX system.
• Ensure compliance with Federal/State guidelines.

Skills

Revenue Integrity

Medical Coding

Communication

Education

High School Diploma

Associate's degree

Job description

Guidehouse is seeking a Revenue Integrity Coding Billing Specialist for a 100% remote role in the United States. You will support revenue cycle activities by reviewing Medicare and third-party payer accounts, applying pre-bill edits, and resolving denials.

Responsibilities include coding with ICD-10, CPT and HCPCS Level II, verifying medical necessity, and ensuring compliance with guidelines. AAPC or AHIMA certification and 5+ years of experience are required.