Guidehouse Managed Services LLC is hiring a Revenue Integrity Coding Billing Specialist. Under the direction of the Director of Revenue Integrity, you will provide revenue cycle support by efficiently reviewing and resolving assigned Medicare and third-party payer accounts subject to pre-bill edits and claim denials. This position is 100% remote.
What You'll Do
- Resolve assigned claims with Revenue Integrity pre-bill edits and specific hold codes in the hospital billing scrubber daily.
- Resolve standard billing edits, including Correct Coding Initiatives (CCI), Medically Unlikely Edits (MUE), and Medical Necessity edits.
- Review clinical documentation and diagnostic results to validate and apply appropriate ICD-10, CPT, HCPCS codes and modifiers.
- Manage the daily resolution of assigned claims with Revenue Integrity-specific denials in the Guidehouse METRIX℠ system.
- Ensure coding and billing practices comply with Federal and State guidelines using authoritative resources.
- Maintain current knowledge of Medicare, Medicaid, and third-party payer billing compliance guidelines.
- Perform other duties as determined by the Director of Revenue Integrity.
What We're Looking For
- High School Diploma or equivalent.
- 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 from provider/clinical documentation.
- Knowledge and application of Medicare, Medicaid, and third-party payer UB-04 billing and reporting requirements, including resolving CCI, MUE, and Medical Necessity edits.
- Proficiency in determining accurate medical codes for outpatient diagnoses, procedures, and services.
- Knowledge of current code bundling rules, compliance, and outpatient reimbursement systems.
- Understanding of hospital charge description master coding systems.
- Strong verbal, written, and interpersonal communication skills.
- Ability to produce accurate work within specified time frames.
Nice to Have
- 5 years' experience in Revenue Integrity Coding and Billing.
- Hospital medical billing and auditing experience.
- Associate's degree.
Technical Stack
- ICD-10
- CPT
- HCPCS Level II
- Guidehouse METRIX℠ system
Team & Environment
You will report directly to the Director of Revenue Integrity.
Benefits & Compensation
- Salary Range: $56,000.00-$94,000.00.
- 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 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.
Work Mode
This is a 100% remote position.
Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.
