Guidehouse

Revenue Integrity Analyst, Medical Biller

Guidehouse

full-time

Posted on:

Location Type: Hybrid

Location: San Antonio • Texas • Virginia • United States

Visit company website

Explore more

✨ AI Apply
Apply

Salary

💰 $80,000 - $133,000 per year

About the role

  • Guidehouse is seeking a Revenue Integrity Analyst (Medical Biller) with strong billing, coding, and revenue cycle expertise to support the modernization of MHS GENESIS, the DoD’s enterprise EHR.
  • Ensure accurate billing, compliant charge capture, and efficient claim resolution by analyzing data, auditing documentation, and collaborating with clinical, coding, IT, and financial teams across the Military Health System.
  • Optimize and validate MHS GENESIS / Cerner charge capture workflows, CDM logic, billing rules, and revenue cycle configuration.
  • Conduct charge capture validation, reconciliation of clinical activity to billing outputs, and identification of DNFB risks and revenue leakage.
  • Audit documentation and coding (ICD‑10‑CM, CPT/HCPCS, modifiers) to ensure NCCI, LCD/NCD, TRICARE, and DHA compliance.
  • Investigate claim edits and denials using Alpha II, SSI, or related tools; identify root causes and implement sustainable solutions.
  • Perform payer remittance analysis to uncover denial trends, modifier issues, bundling errors, and reimbursement gaps.
  • Support UB‑04 and CMS‑1500 billing accuracy and troubleshoot errors impacting payer acceptance or reimbursement.
  • Analyze clinical, financial, and operational data to identify trends and develop data‑driven recommendations for revenue improvement.
  • Prepare executive‑level reporting and visualizations to communicate findings, risks, and remediation strategies.
  • Partner with coding teams, clinicians, IT analysts, billing offices, and leadership to resolve issues and ensure standardized workflows.
  • Participate in or lead enterprise-level remediation planning, including root cause analysis, corrective action tracking, and workflow optimization.
  • Provide staff education on coding, documentation requirements, and revenue cycle best practices.
  • Recommend and implement workflow improvements to reduce denials, increase first-pass payment rates, and enhance compliance.
  • Identify and escalate systemic issues affecting charge capture, coding, billing, or payer processing.

Requirements

  • Must be able to OBTAIN and MAINTAIN a Federal or DoD "PUBLIC TRUST"; candidates must obtain approved adjudication of their PUBLIC TRUST prior to onboarding with Guidehouse.
  • Bachelors Degree
  • FOUR (4) or more years of Revenue Cycle Management (RCM) build experience, including troubleshooting, system reconfiguration, and/or project management.
  • Bachelor’s Degree in Business, Management, Healthcare Administration, Business Analysis, Statistics, or related field
  • Proficiency in ICD‑10‑CM, CPT/HCPCS, modifiers, NCCI, and federal billing regulations (TRICARE, DHA).
  • Understanding of Chargemaster (CDM) structure and charge reconciliation processes.
  • Experience with MHS GENESIS / Cerner, charge capture, billing workflows, and revenue integrity functions.
  • Strong skills in denial root cause analysis, remittance interpretation, and claim lifecycle management.
  • Familiarity with claim scrubber tools, billing systems, and payer edit logic.
  • Strong analytical and critical‑thinking skills with ability to interpret complex data and interpret Excel‑based or system‑generated dashboards.
  • Effective communication skills with the ability to train, educate, and influence stakeholders.
  • Understanding of healthcare billing, medical necessity, and revenue cycle operations.
  • Experience working within the Military Health System (MHS) or other federal health systems.
  • Background in hospital or professional billing environments.
  • Certifications such as CPC, CCS, CPMA, or RHIT/RHIA.
  • Prior consulting experience or participation in large‑scale EHR or revenue cycle implementations.
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 and Adoption Assistance
  • 401(k) Retirement Plan
  • Basic Life & Supplemental Life
  • Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
  • Short-Term & Long-Term Disability
  • Student Loan PayDown
  • Tuition Reimbursement, Personal Development & Learning Opportunities
  • Skills Development & Certifications
  • Employee Referral Program
  • Corporate Sponsored Events & Community Outreach
  • Emergency Back-Up Childcare Program
  • Mobility Stipend
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
billingcodingrevenue cycle managementICD-10-CMCPT/HCPCSNCCIcharge captureremittance analysisdata analysisworkflow optimization
Soft Skills
analytical skillscritical-thinking skillseffective communicationtrainingcollaborationproblem-solvinginfluencing stakeholdersproject managementroot cause analysiseducation
Certifications
CPCCCSCPMARHITRHIA