Revenue Integrity Coding Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Deliver revenue cycle support services under the guidance of the Director of Revenue Integrity

• Examine and promptly resolve Medicare and third-party payer accounts designated for pre-bill claim edits, hospital billing scrubber bill hold edits, and claim denials

• Address assigned claims with Revenue Integrity pre-bill edits and specific Revenue Integrity Hold Codes in the hospital billing scrubber

• Tackle standard billing edits, including Correct Coding Initiatives (CCI), Medically Unlikely Edits (MUE), Medical Necessity edits, and other claim-level edits

• Assess clinical documentation and diagnostic results as necessary to validate and apply ICD-10, CPT, HCPCS codes, and relevant coding modifiers

• Resolve specific Revenue Integrity denials in the Guidehouse METRIX℠ system

• Ensure that coding and billing practices adhere to Federal/State guidelines using authoritative resources

• Keep up-to-date with Medicare, Medicaid, and third-party payer billing compliance guidelines and requirements

• Perform additional duties aligned with skills and experience as assigned by the Director of Revenue Integrity

⛳️ Requirements

• High School Diploma (Relevant experience may substitute for formal education)

• Over 5 years of experience in Revenue Integrity

• AAPC or AHIMA coding certification

• Proficiency in ICD-10, CPT, and HCPCS Level II Coding

• Expertise in assessing the medical necessity of services provided and charged based on provider/clinical documentation

• Comprehensive knowledge, understanding, and correct application of Medicare, Medicaid, and third-party payer UB-04 billing and reporting requirements, including the resolution of CCI, MUE, and Medical Necessity edits applied to claims

• Proficient in identifying accurate medical codes for diagnoses, procedures, and services conducted in the outpatient setting

• Familiarity with current code bundling rules and regulations, compliance, and reimbursement under outpatient grouping systems such as Medicare OPPS and Medicaid or Commercial Insurance EAPG’s

• Understanding of hospital charge description master coding systems and structures

• Strong verbal, written, and interpersonal communication abilities

• Capability to produce precise assigned work within specified deadlines

• Hospital medical billing and auditing experience is preferred as a nice-to-have

• An Associate's degree is preferred as a nice-to-have

🏝️ 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

• Flexible benefits package

• Flexible work arrangement (100% remote)