Revenue Integrity Coding and Billing Specialist- Remote

Revenue Integrity Coding and Billing Specialist
- Remote

Join to apply for the Revenue Integrity Coding and Billing Specialist
- Remote role at Guidehouse
.

Under the direction of the Director of Revenue Integrity, the Revenue Integrity Coding Billing Specialist provides revenue cycle support services through efficient review and prompt 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.

General Coding

None

None

• Daily resolution of assigned claims with Revenue Integrity pre-bill edits and/or specific Revenue Integrity Hold Codes in the hospital billing scrubber.
• Resolve standard billing edits such as Correct Coding Initiative, Medically Unlikely Edits (MUE), Medical Necessity edits, and other claim-level edits as assigned.
• Review clinical documentation and diagnostic results as appropriate to confirm and apply applicable ICD-10, CPT, HCPCS codes and associated coding modifiers.
• Resolve assigned claims with Revenue Integrity specific denials in the Guidehouse METRIX system.
• Ensure coding and billing practices follow Federal/State guidelines by using diverse authoritative information.
• Maintain current knowledge of Medicare, Medicaid, and other third-party payer billing compliance guidelines and requirements.
• Perform other duties as determined by the Director of Revenue Integrity.

• 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 to determine medical necessity of services based on provider/clinical documentation.
• Knowledge of Medicare, Medicaid, and third-party payer UB-04 billing and reporting requirements including resolution of CCI, MUE, and Medical Necessity edits.
• Ability to assign accurate medical codes for diagnoses, procedures, and services performed in the outpatient setting.
• Knowledge of current code bundling rules, compliance, and reimbursement under outpatient grouping systems such as Medicare OPPS and Medicaid or Commercial Insurance EAPG’s.
• Knowledge of hospital charge description master coding systems and structures.
• Ability to produce correct work product within specified periods.

• Hospital medical billing and auditing experience
• Associate degree
• Experience or working knowledge of EPIC

The annual salary range for this position is $49,000.00–$81,000.00. 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.

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.

• 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

Guidehouse 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.

Associate

Full-time

Accounting/Auditing and Finance

Business Consulting and Services