Revenue Cycle Coding and Billing Specialist

Job Family : General Coding

Travel Required : None

Clearance Required : None

This position is fully remote.

What You Will Do :

As a key member of the Revenue Integrity team, you will provide essential revenue cycle support by efficiently reviewing and resolving assigned Medicare and third-party payer accounts facing pre-bill claim edits, billing scrubber holds, and claim denials.

Your daily responsibilities will include :

Resolving claims affected by Revenue Integrity pre-bill edits and specific hold codes.

Handling standard billing edits such as :

Correct Coding Initiatives (CCI)

• Medically Unlikely Edits (MUE)
• Medical Necessity edits
• Additional claim-level edits as assigned

Reviewing clinical documentation and diagnostic results to accurately apply ICD-10, CPT, HCPCS codes, and coding modifiers.

Resolving Revenue Integrity specific denials through the Guidehouse METRIX system.

Ensuring coding and billing practices comply with Federal and State guidelines using authoritative resources.

Maintaining updated knowledge of Medicare, Medicaid, and third-party payer billing compliance guidelines.

Undertaking additional duties as assigned by the Director of Revenue Integrity that match your skills and experience.

What You Will Need :

High School Diploma or equivalent.

5+ years of experience in Revenue Integrity.

AAPC or AHIMA coding certification.

Proven experience in ICD-10, CPT, and HCPCS Level II coding.

Ability to determine medical necessity based on provider documentation.

In-depth knowledge of Medicare, Medicaid, and third-party payer UB-04 billing requirements, including resolving CCI, MUE, and medical necessity edits.

Proficiency in coding for outpatient services including emergency visits, outpatient clinics, surgeries, and diagnostic testing.

Understanding of code bundling rules and proficiency with outpatient grouping systems such as Medicare OPPS.

Familiarity with hospital charge description master coding systems.

Excellent verbal, written, and interpersonal communication skills.

Capability to deliver accurate work within established time frames.

What Would Be Nice To Have :

5 years’ experience specifically in Revenue Integrity Coding and Billing.

Experience in hospital medical billing and auditing.

Associate's degree.

The annual salary range for this position is $56,000.00 - $94,000.00. Compensation is determined based on various factors, including skills, experience, training, and certifications.

What We Offer :

Guidehouse provides a comprehensive benefits package that includes competitive compensation and supports a diverse workplace. Benefits include :

Medical, Rx, Dental & Vision Insurance

Personal and Family Sick Time & Company Paid Holidays

Potential for a discretionary variable incentive bonus

Parental Leave

401(k) Retirement Plan

Life Insurance Options

Health Savings and Flexible Spending Accounts

Disability Insurance

Tuition Reimbursement and 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. We welcome applications from all qualified individuals regardless of their backgrounds. If you require accommodations during the recruitment process or have any inquiries about our positions, please reach out to our recruiting team.