Experienced Remote Revenue Integrity Coding Billing Specialist – Medicare and Third-Party Payer Account Management

Introduction to Guidehouse At Guidehouse, we're committed to building a diverse and supportive workplace where talented individuals can thrive. As a leader in the industry, we're dedicated to creating a culture that values innovation, collaboration, and growth. Our team is passionate about making a difference, and we're looking for like-minded professionals to join us on this journey. If you're a motivated and experienced Revenue Integrity Coding Billing Specialist looking for a new challenge, we want to hear from you! Job Overview We're seeking a highly skilled and experienced Revenue Integrity Coding Billing Specialist to join our team on a remote basis. As a key member of our revenue cycle support services team, you will be responsible for providing expert review and prompt resolution of assigned Medicare and third-party payer accounts. This is an exciting opportunity to work with a talented team of professionals who share your passion for revenue integrity and coding. Key Responsibilities Under the direction of the Director of Revenue Integrity, provide revenue cycle support services through efficient review and prompt resolution of assigned Medicare and third-party payer accounts. Resolve daily assigned claims with applicable Revenue Integrity pre-bill edits and/or specific Revenue Integrity Hold Codes in the hospital billing scrubber, including tasks such as: Correct Coding Initiative (CCI) Medically Unlikely Edits (MUE) Medical Necessity edits 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. Resolve daily assigned claims with Revenue Integrity specific denials in the Guidehouse METRIX system. 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. Perform other duties as determined by the Director of Revenue Integrity, utilizing your skills and experience to drive success. Essential Qualifications To be successful in this role, you will need: A high school diploma and 3-5 years of prior relevant experience in revenue integrity coding and billing. AAPC or AHIMA coding certification. Experience in ICD-10, CPT, and HCPCS Level II Coding. Ability to determine 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 to determine accurate medical codes for diagnoses, procedures, and services performed in the outpatient setting. Knowledge of current code bundling rules and regulations, along with the ability to address 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. Preferred Qualifications While not essential, the following qualifications are highly desirable: 5 years' experience in Revenue Integrity Coding and Billing. Hospital medical billing and auditing experience. Associate degree. Skills and Competencies To excel in this role, you will need to possess: Strong analytical and problem-solving skills, with the ability to interpret complex data and make informed decisions. Excellent communication and interpersonal skills, with the ability to work effectively with cross-functional teams. Strong attention to detail, with the ability to maintain accuracy and quality in a fast-paced environment. Ability to work independently and as part of a team, with a strong sense of accountability and responsibility. Strong knowledge of revenue integrity coding and billing principles, with the ability to apply this knowledge in a practical setting. Career Growth Opportunities and Learning Benefits At Guidehouse, we're committed to helping our employees grow and develop in their careers. As a Revenue Integrity Coding Billing Specialist, you will have access to a range of training and development opportunities, including: Professional certification programs, such as AAPC or AHIMA. On-the-job training and mentorship, with experienced professionals who can provide guidance and support. Opportunities for career advancement, with a clear path for progression and growth. Access to industry-leading conferences and events, with the opportunity to network with peers and stay up-to-date with the latest developments in the field. Work Environment and Company Culture At Guidehouse, we're proud of our diverse and supportive workplace culture. As a remote employee, you will be part of a virtual team that values collaboration, innovation, and creativity. Our company culture is built on a foundation of: Respect and inclusivity, with a commitment to diversity and equal opportunities. Open communication and transparency, with regular updates and feedback. Collaboration and teamwork, with a focus on shared goals and objectives. Continuous learning and development, with a commitment to helping our employees grow and succeed. Compensation, Perks, and Benefits We offer a competitive salary range of $49,400.00-$74,200.00, depending on experience and qualifications. Our comprehensive benefits package includes: Medical, Rx, Dental, and Vision Insurance. Personal and Family Sick Time and Company Paid Holidays. Position may be eligible for a discretionary variable incentive bonus. Parental Leave. 401(k) Retirement Plan. Basic Life and Supplemental Life. Health Savings Account, Dental/Vision, and Dependent Care Flexible Spending Accounts. Short-Term and Long-Term Disability. Tuition Reimbursement, Personal Development, and Learning Opportunities. Skills Development and Certifications. Employee Referral Program. Corporate Sponsored Events and Community Outreach. Emergency Back-Up Childcare Program. Conclusion If you're a motivated and experienced Revenue Integrity Coding Billing Specialist looking for a new challenge, we encourage you to apply for this exciting opportunity. With a competitive salary, comprehensive benefits package, and a commitment to career growth and development, this is a role that offers everything you need to succeed. Don't hesitate – submit your application today and take the first step towards a rewarding and challenging career with Guidehouse! : Apply for this job