Remote Revenue Integrity Coding Specialist

Guidehouse; Washington (District of Columbia); Remote; USD 59,000 - 98,000; Full time

Job summary

Guidehouse is seeking a remote Revenue Integrity Coding Billing Specialist to support pre-bill edits, hospital billing scrubs, and claim denials for Medicare and third-party payers. You will resolve claims daily using CCI, MUE, and medical necessity edits and ensure compliant billing practices.

The role requires 5+ years in Revenue Integrity, a coding certification (AAPC or AHIMA), ICD-10, CPT, HCPCS Level II expertise, and experience with UB-04 billing.

Qualifications

• 5+ years of Revenue Integrity coding and billing experience.
• Proficiency in ICD-10, CPT, HCPCS Level II coding.
• Ability to determine medical necessity from documentation.
• Knowledge of UB-04 billing and Medicare/Medicaid guidelines.

Responsibilities

• Resolve assigned claims with applicable Revenue Integrity pre-bill edits and/or Hold Codes.
• Review clinical documentation and coding to validate and apply codes and modifiers.
• Resolve denials in Guidehouse METRIX system in a timely manner.
• Ensure compliance with Federal/State payer guidelines and requirements.

Skills

ICD-10 Coding

CPT Coding

HCPCS Level II

Medicare/Medicaid knowledge

Billing compliance

Education

AAPC or AHIMA certification

Tools

METRIX system

Job description

Guidehouse is seeking a remote Revenue Integrity Coding Billing Specialist to support pre-bill edits, hospital billing scrubs, and claim denials for Medicare and third-party payers. You will resolve claims daily using CCI, MUE, and medical necessity edits and ensure compliant billing practices.

The role requires 5+ years in Revenue Integrity, a coding certification (AAPC or AHIMA), ICD-10, CPT, HCPCS Level II expertise, and experience with UB-04 billing.