Guidehouse
RevenueIntegrityCodingBillingSpecialist
“Revenue Integrity Coding Billing Specialist at Guidehouse. Skills: Revenue Integrity, Coding, Billing, Claim resolution, Medicare and third-party payer guidelines. Daily resolution of assigned claims with applicable Revenue Integrity pre-bill edits and/or specific Revenue Integrity Hold Codes in the hospital billing scrubber. Resolving standard billing edits such as Correct Coding Initiatives (CCI), Medically Unlikely Edits (MUE), Medical Necessity edits, and other claim level edits”
Industry & Context.
Timely resolution of assigned Medicare and third party payer accounts; Resolution of claim edits and denials
None
What They're Looking For.
Must Have
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 such as Medicare OPPS and Medicaid or Commercial Insurance EAPG’s, Knowledge and understanding of hospital charge description master coding systems and structures
Nice to Have
5 years' experience in Revenue Integrity Coding and Billing, Hospital medical billing and auditing experience, Associate's degree
What You'll Do.
Daily resolution of assigned claims with applicable Revenue Integrity pre-bill edits and/or specific Revenue Integrity Hold Codes in the hospital billing scrubber
Resolving standard billing edits such as Correct Coding Initiatives (CCI)
Medically Unlikely Edits (MUE)
Medical Necessity edits
and other claim level edits
Review clinical documentation and diagnostic results to validate and apply applicable ICD-10
HCPCS codes and associated coding modifiers
Daily resolution of assigned claims with Revenue Integrity specific denials in the Guidehouse METRIX℠ system
Ensuring coding and billing practices are in compliance with Federal/State guidelines
Maintaining current knowledge of Medicare
and other third-party payer billing compliance guidelines and requirements
How You'll Work.
Communication Scope
Verbal communication skills; Written communication skills; Interpersonal communication skills
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