Revenue Integrity Coding Billing Supervisor

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $61k - $101k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📊 Billing Specialist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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

• Investigate, track and resolve health care claim billing errors and denials • Support the Revenue Integrity Program and improve compliance with government, managed care and third-party payer billing and reporting requirements • Collaborate with CRCM project team and client stakeholders on continuous process improvements and Revenue Integrity KPIs • Review and resolve assigned Medicare and third-party payer accounts subject to pre-bill claim edits, hospital billing scrubber hold edits and claim denials • Resolve CCI, MUE, Medical Necessity and other claim-level billing edits • Review clinical documentation and diagnostic results to validate and apply ICD-10, CPT, HCPCS codes and coding modifiers • Resolve Revenue Integrity-specific denials in the Guidehouse METRIX system • Ensure coding and billing practices comply with Federal/State guidelines • Maintain current knowledge of Medicare, Medicaid and third-party payer billing compliance requirements • Collaborate with departments and professionals to resolve revenue integrity issues • Supervise and train RI staff to ensure appropriate reimbursement and compliance • Develop and maintain client policies and procedures • Act as liaison between RI teams and client, communicating expectations clearly • Review new RI team members’ work for compliance and quality before release • Monitor staff productivity, workload and workflows to meet turnaround standards • Determine staffing needs and adjust schedules • Complete employee timesheets and time-off entries in the payroll system • Assist with interviewing and hiring qualified RI staff • Participate in monthly client and RI team conference calls • Provide daily support to resolve facility-related problems and questions • Evaluate team member competency and provide ongoing training and development

🎯 Requirements

• University degree or equivalent of 5 years job related experience • Must have three years management experience • AAPC or AHIMA coding certification required • 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 • Experience resolving 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 • Knowledge of current code bundling rules and regulations • Proficiency on 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 • Word/Excel proficient • Ability to produce accurate assigned work product within specified time frames • Hospital medical billing and auditing experience preferred • Travel required up to 10% • No security clearance required

🏖️ 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