Guidehouse · 8 hours ago
Revenue Integrity Coding and Billing Specialist- Remote
United States
Full-time
Remote
Mid, Senior Level
$56K/yr - $94K/yr
5+ years expGuidehouse is a company that provides revenue cycle support services. The Revenue Integrity Coding and Billing Specialist is responsible for resolving claims related to Medicare and third-party payer accounts, ensuring compliance with coding and billing practices.
AdviceConsultingManagement Consulting
Responsibilities
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
Tasks associated with this work include resolving standard billing edits such as:
Correct Coding Initiative
Medically Unlikely Edits (MUE)
Medical Necessity edits
Other claim level edits as assigned
As needed, review clinical documentation and diagnostic results as appropriate to confirm and apply applicable ICD-10, CPT, HCPCS codes and associated coding modifiers
Responsible for daily resolution of assigned claims with Revenue Integrity specific denials in the Guidehouse METRIX℠ system
Ensures coding and billing practices follow Federal/State guidelines by using diverse types of authoritative information
Maintains current knowledge of Medicare, Medicaid, and other third-party payer billing compliance guidelines and requirements
Other duties equal with skills and experience as determined by the Director of Revenue Integrity
Qualification
Required
High School Diploma/GED (Relevant experience may be substituted for formal education)
5+ 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. For example: emergency department visits, outpatient clinic visits, same day surgeries, diagnostic testing (radiology, imaging, and laboratory), and outpatient therapies (physical therapy, occupational therapy, speech therapy, and chemotherapy)
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
Preferred
Hospital medical billing and auditing experience
Associate degree
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
Company
Guidehouse
Guidehouse offers consulting services for public and commercial markets with expertise in management, technology, and risk consulting.
10001+ employees
H1B Sponsorship
Guidehouse has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (25)
2024 (20)
2023 (29)
2022 (49)
2021 (50)
2020 (59)
Funding
Current Stage
Late StageTotal Funding
$0.75MKey Investors
Mission Daybreak
2023-11-06Acquired
2023-02-16Grant· $0.75M
Leadership Team
Scott McIntyre
Chairman and CEO
Alicia Harkness
Partner
Recent News
Washington Technology
2025-11-20
Washington Technology
2025-11-19
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