Revenue Integrity Coding and Billing Specialist
Guidehouse
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $49,000 - $81,000 per year
Job Level
Mid-LevelSenior
About the role
- Provide revenue cycle support services through efficient review and prompt 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
- Resolve standard billing edits such as: Correct Coding Initiative, Medically Unlikely Edits (MUE), Medical Necessity edits, and 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
- 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.
Requirements
- High School Diploma/GED (Relevant experience may be substituted for formal education)
- 3+ 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
- 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.
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 Level II codingRevenue Integritybilling compliancemedical necessity determinationcode bundling rulesoutpatient grouping systemsUB-04 billingcoding modifiers
Soft skills
attention to detailproblem-solvingtime managementanalytical skillscommunication skills
Certifications
AAPC coding certificationAHIMA coding certification