Guidehouse
Revenue Integrity Coding and Billing Specialist- Remote
Guidehouse, Washington, District of Columbia, us, 20022
Revenue Integrity Coding and Billing Specialist – Remote
Guidehouse invites candidates for the Revenue Integrity Coding and Billing Specialist – Remote role. The position offers 100% remote work, competitive compensation ranging from $56,000 to $94,000, and a total rewards package that includes medical, dental, vision, 401(k), disability, tuition reimbursement, and employee development opportunities.
What You Will Do Under the direction of the Director of Revenue Integrity, the Specialist provides revenue cycle support services through efficient review and prompt resolution of assigned Medicare and third-party payer accounts that are subject to pre‑bill claim edits, hospital billing scrubber hold edits, and claim denials.
Responsibilities
Daily resolution of assigned claims with Revenue Integrity pre‑bill edits and specific hold codes.
Correct Coding Initiative, Medically Unlikely Edits (MUE), medical necessity edits, and other claim‑level edits.
Review clinical documentation and diagnostic results to confirm and apply ICD‑10, CPT, HCPCS codes and modifiers.
Resolve Revenue Integrity denials using the Guidehouse METRIX system.
Maintain knowledge of Medicare, Medicaid, and third‑party payer billing compliance guidelines.
Other duties as determined by the Director of Revenue Integrity.
What You Will Need
High School Diploma/GED (experience may substitute 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.
Demonstrated ability to determine medical necessity based on provider documentation.
Knowledge of Medicare, Medicaid, and third‑party payer UB‑04 billing and reporting requirements.
Understanding of hospital charge description master coding systems.
Ability to meet work product deadlines.
Hospital medical billing and auditing experience (nice to have).
Associate degree (nice to have).
Benefits
Medical, Rx, dental, and vision insurance.
Personal and family sick time and company‑paid holidays.
Discretionary variable incentive bonus (eligible).
Parental leave.
401(k) retirement plan.
Basic life and supplemental life insurance.
Health savings account, dental/vision, and dependent care flexible spending accounts.
Short‑term and long‑term disability.
Tuition reimbursement and personal development opportunities.
Skills development and certifications.
Employee referral program.
Corporate sponsored events and community outreach.
Emergency backup childcare program.
Equal Opportunity Employment Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities, and any other basis protected by law. Guidance for accommodations: Contact Guidehouse Recruiting at 1‑571‑633‑1711 or via email at RecruitingAccommodation@guidehouse.com.
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What You Will Do Under the direction of the Director of Revenue Integrity, the Specialist provides revenue cycle support services through efficient review and prompt resolution of assigned Medicare and third-party payer accounts that are subject to pre‑bill claim edits, hospital billing scrubber hold edits, and claim denials.
Responsibilities
Daily resolution of assigned claims with Revenue Integrity pre‑bill edits and specific hold codes.
Correct Coding Initiative, Medically Unlikely Edits (MUE), medical necessity edits, and other claim‑level edits.
Review clinical documentation and diagnostic results to confirm and apply ICD‑10, CPT, HCPCS codes and modifiers.
Resolve Revenue Integrity denials using the Guidehouse METRIX system.
Maintain knowledge of Medicare, Medicaid, and third‑party payer billing compliance guidelines.
Other duties as determined by the Director of Revenue Integrity.
What You Will Need
High School Diploma/GED (experience may substitute 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.
Demonstrated ability to determine medical necessity based on provider documentation.
Knowledge of Medicare, Medicaid, and third‑party payer UB‑04 billing and reporting requirements.
Understanding of hospital charge description master coding systems.
Ability to meet work product deadlines.
Hospital medical billing and auditing experience (nice to have).
Associate degree (nice to have).
Benefits
Medical, Rx, dental, and vision insurance.
Personal and family sick time and company‑paid holidays.
Discretionary variable incentive bonus (eligible).
Parental leave.
401(k) retirement plan.
Basic life and supplemental life insurance.
Health savings account, dental/vision, and dependent care flexible spending accounts.
Short‑term and long‑term disability.
Tuition reimbursement and personal development opportunities.
Skills development and certifications.
Employee referral program.
Corporate sponsored events and community outreach.
Emergency backup childcare program.
Equal Opportunity Employment Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities, and any other basis protected by law. Guidance for accommodations: Contact Guidehouse Recruiting at 1‑571‑633‑1711 or via email at RecruitingAccommodation@guidehouse.com.
#J-18808-Ljbffr