Revenue Integrity Coding and Billing Specialist

Job Family : General Coding

Travel Required : None

Clearance Required : None

This position is fully remote

What You Will Do :

Join the Revenue Integrity team, and under the guidance of the Director of Revenue Integrity, provide essential revenue cycle support through the efficient review and resolution of Medicare and third-party payer accounts facing pre-bill claim edits, billing hold edits, and claim denials.

Conduct Charge Master Reconciliation audits to ensure compliance with policies and accurate charge capture.

Develop and implement an audit scorecard to track charge reconciliation efforts.

Address noncompliance with departmental policies and present action plans as necessary.

Resolve claims flagged by Revenue Integrity pre-bill edits and hold codes in the hospital billing scrubber, including :

Correct Coding Initiatives (CCI)

• Medically Unlikely Edits (MUE)
• Medical Necessity edits

Review clinical documentation and diagnostic results to verify and apply appropriate ICD-10, CPT, HCPCS codes, and coding modifiers as needed.

Handle claims resolutions for denials using the Guidehouse METRIX? system efficiently.

Ensure compliance with federal and state coding and billing regulations by leveraging authoritative information sources.

Stay up-to-date with Medicare, Medicaid, and third-party payer billing compliance guidelines and requirements.

Handle additional duties as determined by the Director of Revenue Integrity that align with your skills and experience.

What You Will Need :

High School Diploma or equivalent.

5+ years of experience in Revenue Integrity.

AAPC or AHIMA coding certification.

Proven experience in ICD-10, CPT, and HCPCS Level II coding.

Expertise in assessing medical necessity based on provider documentation.

In-depth knowledge of the UB-04 billing and reporting requirements for Medicare, Medicaid, and third-party payers.

Skill in accurately determining medical codes for various outpatient services such as emergency department visits, outpatient clinic services, same-day surgeries, diagnostic tests, and therapy services.

Understanding of hospital charge description master coding structures and current code bundling rules.

Strong verbal, written, and interpersonal communication skills.

Ability to deliver accurate work within designated timelines.

What Would Be Nice To Have :

5 years' experience specifically in Revenue Integrity Coding and Billing.

Experience in hospital medical billing and auditing.

Associate's degree.

The annual salary range for this position is $56,000.00-$94,000.00. Compensation is based on various factors including experience, skills, certifications, and business needs.

What We Offer :

Guidehouse provides a comprehensive rewards package that includes competitive pay and a flexible benefits plan to foster a diverse and inclusive workplace.

Medical, Rx, Dental & Vision Insurance

Personal and Family Sick Time & Paid Holidays

Possibility for a discretionary variable incentive bonus

Parental Leave

401(k) Retirement Plan

Basic Life & Supplemental Life Insurance

Health Savings Account and Flexible Spending Accounts

Short-Term & Long-Term Disability Insurance

Tuition Reimbursement and Professional Development 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, welcoming Veterans, individuals with disabilities, and all other bases protected by law.

Guidehouse values diversity and will consider qualified applicants with criminal histories as permitted by law.

If you need accommodation during the application process, please contact Guidehouse Recruiting. All information will be kept confidential to provide necessary accommodations.

All recruitment communication will be sent from Guidehouse email domains. Any correspondence from different domains should be treated as unauthorized.

Guidehouse does not charge fees or require money transfers during recruitment, and applicants should not share banking details with unauthorized third parties.

Guidehouse is not responsible for any losses due to unauthorized dealings.

Guidehouse does not accept unsolicited resumes and will not pay placement fees for them.