Overview 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. Responsibilities 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. Resolve standard billing edits such as: Correct Coding Initiative Medically Unlikely Edits (MUE) Medical Necessity edits 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 daily Revenue Integrity denials in the Guidehouse METRIX0 per system. Ensure coding and billing practices follow Federal/State guidelines by using diverse types of authoritative information. Maintain current knowledge of Medicare, Medicaid, and other third-party payer billing compliance guidelines and requirements. Other duties 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 and application of Medicare, Medicaid, and third-party payer UB-04 billing and reporting requirements including resolution of CCI, MUE and Medical Necessity edits. Ability to determine accurate medical codes for diagnoses, procedures and services performed in the outpatient setting (e.g., ED visits, outpatient clinics, same-day surgeries, diagnostic testing, outpatient therapies). Knowledge of current code bundling rules and outpatient reimbursement systems (e.g., Medicare OPPS, Medicaid, or commercial insurance EAPGs). Knowledge of hospital charge description master coding systems and structures. Ability to produce correct work within specified timeframes. What Would Be Nice to Have: Hospital medical billing and auditing experience; Associate degree. What We Offer 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 Life Insurance 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 Salary : The annual salary range for this position is $56,000.00-$94,000.00. 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. About Guidehouse Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you require an accommodation during the application process, please contact Guidehouse Recruiting at 1-571-633-1711 or RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and used only to provide needed reasonable accommodation. #J-18808-Ljbffr Guidehouse
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