Guidehouse · 1 day ago

Revenue Integrity Coding Billing Specialist- Remote

District of Columbia, United States

Full-time

Remote

Mid, Senior Level

$57K/yr - $86K/yr

5+ years exp

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No H1B

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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

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

AAPC certificationAHIMA certificationICD-10 CodingCPT CodingHCPCS Level II CodingMedical Necessity determinationMedicare billing complianceMedicaid billing complianceUB-04 billing requirementsRevenue Integrity Coding experienceHospital charge description masterOutpatient setting codingCode bundling rulesHospital billing experienceSoft skills

Required

High School Diploma/GED and 5+ years of prior relevant experience in lieu of diploma/GED

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.