Revenue Integrity Coding and Billing Specialist

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $56k - $94k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📊 Billing Specialist

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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

• Provide revenue cycle support services under the direction of the Director of Revenue Integrity • Review and promptly resolve assigned Medicare and third-party payer accounts subject to pre-bill claim edits, hospital billing scrubber bill hold edits, and claim denials • Resolve assigned claims with Revenue Integrity pre-bill edits and Revenue Integrity Hold Codes in the hospital billing scrubber • Resolve Correct Coding Initiative, Medically Unlikely Edits, Medical Necessity edits, and other claim-level edits • Review clinical documentation and diagnostic results as needed to confirm and apply ICD-10, CPT, HCPCS codes and coding modifiers • Resolve assigned accounts with Revenue Integrity-specific denials in the Guidehouse METRIX℠ system • Ensure coding and billing practices follow Federal/State guidelines using authoritative information • Maintain current knowledge of Medicare, Medicaid, and third-party payer billing compliance guidelines and requirements • Perform other duties as determined by the Director of Revenue Integrity

🎯 Requirements

• High School Diploma/GED (Relevant experience may be substituted for formal education) • 3+ years of prior Revenue Integrity experience • AAPC or AHIMA coding certification • Experience in ICD-10, CPT and HCPCS Level II Coding • Ability 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 • Ability in determining accurate medical codes for diagnoses, procedures and services performed in the outpatient setting • In-depth understanding of hospital denials from various payors and resolution • Ability to resolve rejected insurance claims for hospital payment requiring claim analysis and understanding of insurance guidelines • Knowledge of current code bundling rules and regulations, compliance, and reimbursement under outpatient grouping systems such as Medicare OPPS and Medicaid or Commercial Insurance EAPGs • Knowledge and understanding of hospital charge description master coding systems and structures • Ability to produce correct assigned work product within specified periods • Ability to obtain Public Trust clearance • 5+ years experience/working knowledge of HB Epic (nice to have) • 5+ years of hospital setting experience (nice to have) • Associate or higher degree (nice to have)

🏖️ 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 • 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 • Flexible benefits package