Revenue Integrity Coding Billing Specialist (remote)

Guidehouse•Raleigh, NC

32d•$56,000 - $94,000•Remote

About The Position

Under the direction of the Director of Revenue Integrity, the Revenue Integrity Coding Billing Specialist provides revenue cycle support services through efficient review and timely 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. Daily duties for this position include: Perform Charge Master Reconciliation audits to ensure departments are following policy and capturing all necessary charges. Incorporating a audit scorecard for charge reconciliation audits Escalate departments noncompliant with policy and provide action plan when needed 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 Initiatives (CCI) Medically Unlikely Edits (MUE) Medical Necessity edits Other claim level edits as assigned As needed, review clinical documentation and diagnostic results as appropriate to validate 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 METRIXâ¢ system. Ensures coding and billing practices are in compliance with Federal/State guidelines by utilizing various types of authoritative information. Maintains 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.

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. For example: emergency department visits, outpatient clinic visits, same day surgeries, diagnostic testing (radiology, imaging, and laboratory), and outpatient therapies (physical therapy, occupational therapy, speech therapy, and chemotherapy)
Knowledge of current code bundling rules and regulations along with proficiency on issues regarding 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.
Strong verbal, written and interpersonal communication skills.
Ability to produce accurate, assigned work product within specified time frames.

Nice To Haves

5 years' experience in Revenue Integrity Coding and Billing
Hospital medical billing and auditing experience
Associate's degree

Responsibilities

Perform Charge Master Reconciliation audits to ensure departments are following policy and capturing all necessary charges.
Incorporate an audit scorecard for charge reconciliation audits
Escalate departments noncompliant with policy and provide action plan when needed
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.
Review clinical documentation and diagnostic results as appropriate to validate 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 METRIXâ¢ system.
Ensures coding and billing practices are in compliance with Federal/State guidelines by utilizing various types of authoritative information.
Maintains 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.

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