Guidehouse
Revenue Integrity Coding and Billing Specialist- Remote
Guidehouse, Washington, District of Columbia, us, 20022
Revenue Integrity Coding and Billing Specialist – Remote
Under the direction of the Director of Revenue Integrity, this role 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 bill hold edits, and claim denials. This position is 100% remote. Annual salary range: $56,000.00–$94,000.00.
What You Will Do
Daily resolution of assigned claims with applicable Revenue Integrity pre‑bill edits, including the Correct Coding Initiative, Medically Unlikely Edits (MUE), Medical Necessity edits, and other claim‑level edits as assigned.
Review clinical documentation and diagnostic results to confirm and apply applicable ICD‑10, CPT, HCPCS codes and coding modifiers.
Resolve Revenue Integrity specific denials in the Guidehouse METRIX system.
Ensure coding and billing practices follow federal and state guidelines by using authoritative information.
Maintain current knowledge of Medicare, Medicaid, and third‑party payer billing compliance guidelines and requirements.
Perform other related duties as directed by the Director of Revenue Integrity.
What You Will Need
High School Diploma or GED (relevant experience may be substituted).
5+ years of prior Revenue Integrity experience.
AAPC or AHIMA coding certification.
Experience with ICD‑10, CPT, and HCPCS Level II coding.
Ability to determine medical necessity of services based on provider/clinical documentation.
Knowledge of Medicare, Medicaid, and UB‑04 billing and reporting requirements, including resolution of CCI, MUE, and Medical Necessity edits.
Ability to determine accurate medical codes for outpatient services such as emergency department visits, outpatient clinic visits, same‑day surgeries, diagnostic testing, and outpatient therapies.
Knowledge of code bundling rules and compliance issues for outpatient grouping systems such as Medicare OPPS and Medicaid or Commercial EAPGs.
Knowledge of hospital charge description master coding systems.
Ability to produce correct work product within specified periods.
Nice to have: Hospital medical billing and auditing experience; Associate degree.
Benefits
Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Discretionary variable incentive bonus (position may be eligible)
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
About Guidehouse Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities, or any other basis protected by law, ordinance, or regulation. Guidehouse considers qualified applicants with criminal histories in accordance with applicable law, including the Fair Chance Ordinance of Los Angeles and San Francisco.
Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in recruitment events. The company provides reasonable accommodations upon request.
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What You Will Do
Daily resolution of assigned claims with applicable Revenue Integrity pre‑bill edits, including the Correct Coding Initiative, Medically Unlikely Edits (MUE), Medical Necessity edits, and other claim‑level edits as assigned.
Review clinical documentation and diagnostic results to confirm and apply applicable ICD‑10, CPT, HCPCS codes and coding modifiers.
Resolve Revenue Integrity specific denials in the Guidehouse METRIX system.
Ensure coding and billing practices follow federal and state guidelines by using authoritative information.
Maintain current knowledge of Medicare, Medicaid, and third‑party payer billing compliance guidelines and requirements.
Perform other related duties as directed by the Director of Revenue Integrity.
What You Will Need
High School Diploma or GED (relevant experience may be substituted).
5+ years of prior Revenue Integrity experience.
AAPC or AHIMA coding certification.
Experience with ICD‑10, CPT, and HCPCS Level II coding.
Ability to determine medical necessity of services based on provider/clinical documentation.
Knowledge of Medicare, Medicaid, and UB‑04 billing and reporting requirements, including resolution of CCI, MUE, and Medical Necessity edits.
Ability to determine accurate medical codes for outpatient services such as emergency department visits, outpatient clinic visits, same‑day surgeries, diagnostic testing, and outpatient therapies.
Knowledge of code bundling rules and compliance issues for outpatient grouping systems such as Medicare OPPS and Medicaid or Commercial EAPGs.
Knowledge of hospital charge description master coding systems.
Ability to produce correct work product within specified periods.
Nice to have: Hospital medical billing and auditing experience; Associate degree.
Benefits
Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Discretionary variable incentive bonus (position may be eligible)
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
About Guidehouse Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities, or any other basis protected by law, ordinance, or regulation. Guidehouse considers qualified applicants with criminal histories in accordance with applicable law, including the Fair Chance Ordinance of Los Angeles and San Francisco.
Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in recruitment events. The company provides reasonable accommodations upon request.
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