Revenue Integrity Coding Specialist

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $59k - $98k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

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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 timely 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 specific Revenue Integrity Hold Codes in the hospital billing scrubber • Resolve standard billing edits, including Correct Coding Initiatives (CCI), Medically Unlikely Edits (MUE), Medical Necessity edits, and other claim-level edits • Review clinical documentation and diagnostic results as needed to validate and apply ICD-10, CPT, HCPCS codes and associated coding modifiers • Resolve assigned Revenue Integrity-specific denials in the Guidehouse METRIX℠ system • Ensure coding and billing practices comply with Federal/State guidelines using authoritative information • Maintain current knowledge of Medicare, Medicaid, and third-party payer billing compliance guidelines and requirements • Perform other duties commensurate with skills and experience as determined by the Director of Revenue Integrity

🎯 Requirements

• 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 • Knowledge of current code bundling rules and regulations, 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 • Hospital medical billing and auditing experience preferred as a nice-to-have • Associate's degree preferred as a 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 • Flexible work arrangement (100% remote)

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