Revenue Integrity Coding Billing 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

Job Family:General CodingTravel Required:NoneClearance Required:NoneWhat 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.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 editsOther claim level edits as assignedAs 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 experienceAAPC 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 BillingHospital medical billing and auditing experienceAssociate's degree#IndeedSponsored #LI-DNIThe 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.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.Benefits include:Medical, Rx, Dental & Vision InsurancePersonal and Family Sick Time & Company Paid HolidaysPosition may be eligible for a discretionary variable incentive bonusParental Leave401(k) Retirement PlanBasic Life & Supplemental LifeHealth Savings Account, Dental/Vision & Dependent Care Flexible Spending AccountsShort-Term & Long-Term DisabilityTuition Reimbursement, Personal Development & Learning OpportunitiesSkills Development & CertificationsEmployee Referral ProgramCorporate Sponsored Events & Community OutreachEmergency Back-Up Childcare ProgramAbout GuidehouseGuidehouse 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. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact [e-mail]. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.