Medical Coding and Reimbursement Specialist

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🔥 0 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $98k - $163k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🏥 Medical Billing and Coding

🚫👨‍🎓 No degree required

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Guidehouse

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2018

🏥 Healthcare

🎖️ Defense

📦 Logistics

💰 Grant on 2023-02

Healthcare • Defense • Logistics

Guidehouse is a global consultancy offering advisory, digital, and managed services across commercial and public sectors. It is purpose-built to support industries such as national security, financial services, healthcare, energy, and infrastructure. Guidehouse collaborates with leaders to navigate complexity and drives transformational changes that impact the future. Their expertise spans data analytics, digital technologies, risk management, and more, with a strong emphasis on sustainability and innovation.

📋 Description

• Develop, refine, and maintain CPT, HCPCS, ICD-10, modifier, revenue code, and ancillary service code groupings • Support development of code sets representing episodes of care, treatment pathways, and healthcare services • Research coding guidance, Medicare policies, reimbursement methodologies, and billing requirements • Identify related, supporting, bundled, ancillary, add-on, and downstream services associated with diagnoses and procedures • Validate code sets against Medicare requirements, fee schedules, reimbursement policies, NCCI edits, and coding standards • Review provider billing practices and claims patterns to identify missing, duplicative, or inappropriate code relationships • Document coding rationale, business rules, assumptions, exclusions, and validation findings • Participate in coding reviews, clinical reviews, quality control activities, and stakeholder reviews • Collaborate with clinicians, reimbursement SMEs, and analytics teams • Support governance processes, change requests, maintenance activities, and version control efforts

🎯 Requirements

• 2+ years of experience in medical coding, reimbursement, payment integrity, auditing, compliance, revenue cycle, or claims operations • Strong knowledge of CPT, HCPCS, ICD-10-CM, ICD-10-PCS, revenue codes, modifiers, Medicare reimbursement methodologies, claims adjudication, provider billing workflows, NCCI edits, and fee schedules • Experience in payer, provider, TPA, Medicare, Medicaid, TRICARE, Commercial, or Federal healthcare environments • Ability to translate coding guidance and reimbursement requirements into operationally actionable code set recommendations • One or more of the following certifications: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA), Certified Risk Adjustment Coder (CRC), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified in Healthcare Compliance (CHC), Certified Emergency Department Coding Specialist (CEDC), Certified OBGYN Coding Specialist (COBGC), or Certified Orthopedic Surgical Coding Specialist (COSC) • Preferred: experience supporting federal health programs, Medicare-based payment models, or large payer environments • Preferred: exposure to authorization, utilization management, payment integrity, or claims analytics initiatives • Preferred: experience translating coding and reimbursement logic into business rules, validation criteria, or operational requirements • Preferred: familiarity with specialty-specific coding areas • Preference for candidates local to the Washington, DC metro area • Ability to obtain Public Trust clearance

🏖️ Benefits

• 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 and Adoption Assistance • 401(k) Retirement Plan • Basic Life & Supplemental Life • Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts • Short-Term & Long-Term Disability • Student Loan PayDown • Tuition Reimbursement, Personal Development & Learning Opportunities • Skills Development & Certifications • Employee Referral Program • Corporate Sponsored Events & Community Outreach • Emergency Back-Up Childcare Program • Mobility Stipend • Flexible benefits package