Revenue Integrity Coding Billing Specialist
Guidehouse
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $56,000 - $94,000 per year
Job Level
Mid-LevelSenior
About the role
- Provides revenue cycle support services through efficient review and timely resolution of assigned Medicare and third party payer accounts
- 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
- Review clinical documentation and diagnostic results as appropriate to validate and apply applicable ICD-10, CPT, HCPCS codes
- Responsible for daily resolution of assigned claims with Revenue Integrity specific denials in the Guidehouse METRIX℠ system
- Ensures coding and billing practices are in compliance with Federal/State guidelines
- Maintains current knowledge of Medicare, Medicaid, and other third-party payer billing compliance guidelines and requirements
Requirements
- 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 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.
- Proficiency in determining accurate medical codes for diagnoses, procedures and services performed in the outpatient setting.
- Knowledge of current code bundling rules and regulations along with proficiency on issues regarding 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.
- Strong verbal, written and interpersonal communication skills.
- Ability to produce accurate, assigned work product within specified time frames.
Benefits
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
ICD-10 codingCPT codingHCPCS codingRevenue Integritymedical necessity determinationbilling complianceUB-04 billingcode bundling rulesoutpatient grouping systemshospital charge description master coding
Soft skills
verbal communicationwritten communicationinterpersonal communicationtime managementaccuracy
Certifications
AAPC coding certificationAHIMA coding certification