Revenue Integrity Coding Billing Specialist- Remote ID-11014

December 3, 2024

What You Will Do:

Under the direction of the Director of Revenue Integrity, the Revenue Integrity Coding Billing Specialist provides revenue cycle support services through efficient review and prompt 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.

Other Jobs You May Be Interested In

Correct Coding Initiative
Medically Unlikely Edits (MUE)
Medical Necessity edits
Other claim level edits as assigned.
As needed, review clinical documentation and diagnostic results as appropriate to confirm 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 METRIX℠ system
Ensures coding and billing practices follow Federal/State guidelines by using diverse types of authoritative information.
Maintains current knowledge of Medicare, Medicaid, and other third-party payer billing compliance guidelines and requirements.
Other duties equal with skills and experience as determined by the Director of Revenue Integrity.

What You Will Need:

High School Diploma/GED and 5+ years of prior relevant experience in lieu of diploma/GED
AAPC or AHIMA coding certification.
Experience in ICD-10, CPT and HCPCS Level II Coding.
Ability 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.
Ability 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 ability on issues of 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.
Ability to produce correct, assigned work product within specified periods.

What Would Be Nice to Have:
5 years' experience in Revenue Integrity Coding and Billing
Hospital medical billing and auditing experience
Associate degree

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