Revenue Integrity Coding Billing Specialist

Guidehouse; United States; Remoto; USD 59.000 - 98.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, Rx, Dental & Vision Insurance

401(k) Retirement Plan

Tuition Reimbursement

Paid Holidays

Descrizione del lavoro

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.

Competenze

• 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.

Mansioni

• 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.

Conoscenze

Revenue Integrity

Medical Coding

Communication

Formazione

High School Diploma

Associate's degree

Descrizione del lavoro

What You Will Do:

Under the direction of the Director of Revenue Integrity, the Revenue Integrity Coding Billing Specialist provides revenue cycle support services through efficient review and timely resolution of assigned Medicare and third party payer accounts that are subject to pre-bill claim edits, hospital billing scrubber bill hold edits, and claim denials. This position is 100% remote.

The annual salary range for this position is $59,000.00-$98,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

Daily duties for this position include:

• Responsible for the daily resolution of assigned claims with applicable Revenue Integrity pre-bill edits and/or specific Revenue Integrity Hold Codes in the hospital billing scrubber.
• Tasks associated with this work include resolving standard billing edits such as: Correct Coding Initiatives (CCI), Medically Unlikely Edits (MUE), Medical Necessity edits, Other claim level edits as assigned.
• As needed, review clinical documentation and diagnostic results as appropriate to validate and apply applicable ICD-10, CPT, HCPCS codes and associated coding modifiers.
• Responsible for daily resolution of assigned claims with Revenue Integrity specific denials in the Guidehouse METRIX℠ system.
• Ensures coding and billing practices are in compliance with Federal/State guidelines by utilizing various types of authoritative information.
• Maintains current knowledge of Medicare, Medicaid, and other third-party payer billing compliance guidelines and requirements.
• Other duties commensurate with skills and experience as determined by the Director of Revenue Integrity.

What You Will Need:

High School Diploma (Relevant experience may be substituted for formal education)

5+ years of Revenue Integrity experience

AAPC or AHIMA coding certification.

Experience in ICD-10, CPT and HCPCS Level II Coding.

Expertise in determining medical necessity of services provided and charged based on provider/clinical documentation.

Knowledge, understanding and proper application of Medicare, Medicaid, and third-party payer UB-04 billing and reporting requirements including resolution of CCI, MUE and Medical Necessity edits applied to claims.

Proficiency in determining accurate medical codes for diagnoses, procedures and services performed in the outpatient setting. For example: emergency department visits, outpatient clinic visits, same day surgeries, diagnostic testing (radiology, imaging, and laboratory), and outpatient therapies (physical therapy, occupational therapy, speech therapy, and chemotherapy)

Knowledge of current code bundling rules and regulations along with proficiency on issues regarding compliance, and reimbursement under outpatient grouping systems such as Medicare OPPS and Medicaid or Commercial Insurance EAPG’s.

Knowledge and understanding of hospital charge description master coding systems and structures.

Strong verbal, written and interpersonal communication skills.

Ability to produce accurate, assigned work product within specified time frames.

What Would Be Nice To Have:

5 years' experience in Revenue Integrity Coding and Billing Hospital medical billing and auditing experience

Associate's degree

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [e-mail]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or [e-mail]. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse.

Guidehouse is a global AI-led professional services firm delivering advisory, technology, and managed services to the commercial and government sectors. With an integrated business technology approach, Guidehouse drives efficiency and resilience in the healthcare, financial services, energy, infrastructure, and national security markets. Built to help clients across industries outwit complexity, the firm brings together approximately 18,000 professionals to achieve lasting impact and shape a meaningful future.

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