Revenue Integrity Coding and Billing Specialist

Job Family :

General Coding

Travel Required :

None

Clearance Required :

None

What You Will Do :

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 .

Responsible for the daily resolution of assigned claims with applicable Revenue Integrity pre-bill edits and/or specific Revenue Integrity Hold Codes in the hospital billing scrubber. Tasks associated with this work include resolving standard billing edits such as:

• Correct Coding Initiative

• Medically Unlikely Edits (MUE)

• Medical Necessity edits

• Other claim level edits as assigned.

• As needed review clinical documentation and diagnostic results as appropriate to confirm and apply applicable ICD-10 CPT HCPCS codes and associated coding modifiers.

• Responsible for daily resolution of assigned claims with Revenue Integrity specific denials in the Guidehouse METRIX℠ system

• Ensures coding and billing practices follow Federal/State guidelines by using diverse types of authoritative information.

• Maintains current knowledge of Medicare Medicaid and other third-party payer billing compliance guidelines and requirements.

• Other duties equal with skills and experience as determined by the Director of Revenue Integrity.

What You Will Need :

• High School Diploma/GED (Relevant experience may be substituted for formal education)

• 5+ 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. For example: emergency department visits outpatient clinic visits same day surgeries diagnostic testing (radiology imaging and laboratory) and outpatient therapies (physical therapy occupational therapy speech therapy and chemotherapy

• Knowledge of current code bundling rules and regulations along with ability on issues of 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.

• Ability to produce correct assigned work product within specified periods.

• What Would Be Nice to Have :

• Hospital medical billing and auditing experience

• Associate degree

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The annual salary range for this position is $56000.00-$94000.00. 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.

What We Offer :

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.

Benefits include:

• 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

About Guidehouse

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.

If you have visited our website for information about employment opportunities or to apply for a position and you require an accommodation please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected] . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or [email protected] .  Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse.  Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received please contact [email protected] . Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.