Guidehouse, a "next-generation consultancy" and a portfolio company of Veritas Capital, provides management, risk consulting, and technology services to help cl
Revenue Integrity Coding Billing Specialist
Location
Florida + 3 moreAll locations: Florida | New York | North Carolina | Minnesota
Posted
45 days ago
Salary
$56K - $94K / year
Seniority
Senior
Job Description
Revenue Integrity Coding Billing Specialist
Guidehouse
• Under the direction of the Director of Revenue Integrity, provide revenue cycle support services through efficient review and timely resolution of assigned Medicare and third-party payer accounts • Daily resolution of assigned claims with applicable Revenue Integrity pre-bill edits and/or specific Revenue Integrity Hold Codes in the hospital billing scrubber • Resolve standard billing edits such as: Correct Coding Initiatives (CCI), Medically Unlikely Edits (MUE), Medical Necessity edits, and other claim level edits as assigned • Review clinical documentation and diagnostic results to validate and apply applicable ICD-10, CPT, HCPCS codes and associated coding modifiers • Ensure coding and billing practices are in compliance with Federal/State guidelines by utilizing various types of authoritative information • Maintain current knowledge of Medicare, Medicaid, and other third-party payer billing compliance guidelines and requirements • Other duties commensurate with skills and experience as determined by the Director of Revenue Integrity
Job Requirements
- High School Diploma or equivalent
- 5+ years of Revenue Integrity experience
- AAPC or AHIMA coding certification
- Experience in ICD-10, CPT and HCPCS Level II Coding
- Expertise 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
- Proficiency 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 proficiency on issues regarding compliance, and reimbursement under outpatient grouping systems
- Knowledge and understanding of hospital charge description master coding systems and structures
- Strong verbal, written and interpersonal communication skills
- Ability to produce accurate, assigned work product within specified time frames.
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
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