Job Overview
Location
US - Remote (Any location)
Job Type
Full-time
Category
Software Engineering
Date Posted
May 17, 2026
Full Job Description
đź“‹ Description
- • Review multi-specialty inpatient and outpatient clinical charge correction requests to ensure accurate ICD-10, CPT, and HCPCS coding.
- • Interpret and apply Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) to validate medical necessity of billed services.
- • Verify compliance with Medicare, Medicaid, and third-party payer billing guidelines, including resolution of CCI, MUE, and Medical Necessity edits on claims.
- • Accurately assign medical codes for diagnoses, procedures, and services across diverse clinical settings including emergency department visits, outpatient clinics, same-day surgeries, diagnostic imaging, laboratory tests, and outpatient therapies (physical, occupational, speech, and chemotherapy).
- • Identify and correct coding errors that impact reimbursement and revenue integrity, ensuring alignment with outpatient grouping systems such as Medicare OPPS and Medicaid/Commercial Insurance EAPGs.
- • Electronically file replacement claims and perform limited payment posting as required to support collections teams.
- • Communicate coding discrepancies and regulatory changes to relevant revenue cycle teams to facilitate timely adjustments and claim resubmissions.
- • Utilize MS Excel for data analysis, claim reconciliation, and reporting tasks related to charge correction activities.
- • Conduct coding reviews under strict compliance standards, maintaining adherence to federal and commercial payer regulations and industry best practices.
- • Participate in M-F onsite training for approximately 3–6 months, after which the role transitions to a hybrid model with 90% remote work.
- • Apply knowledge of current code bundling rules and regulatory updates to prevent improper billing and ensure accurate reimbursement.
- • Evaluate provider clinical documentation to determine the appropriate level of service and corresponding code assignment, ensuring documentation supports billed charges.
- • Maintain awareness of evolving coding guidelines and payer policies to uphold accuracy and compliance across all charge correction activities.
- • Collaborate cross-functionally with revenue cycle and billing departments to resolve claim denials and improve coding quality.
- • Ensure all corrected claims meet documentation, coding, and regulatory standards prior to resubmission to payers.
🎯 Requirements
- • High School Diploma or GED (relevant experience may substitute for formal education)
- • 1+ years of medical coding experience
- • AAPC CPC or AHIMA CCS coding certification
- • Experience with ICD-10, CPT, and HCPCS Level II coding
- • Ability to determine medical necessity based on clinical documentation
- • Knowledge of Medicare, Medicaid, and third-party payer HCFA-1500 billing requirements including CCI, MUE, and Medical Necessity edits
🏖️ Benefits
- • Medical, Rx, Dental & Vision Insurance
- • Personal and Family Sick Time & Company Paid Holidays
- • 401(k) Retirement Plan
- • Parental Leave
- • Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- • Tuition Reimbursement, Personal Development & Learning Opportunities
Skills & Technologies
See exactly how your profile matches this role — strengths, skill gaps, and what to do about them.
About Guidehouse Inc.
Guidehouse Inc. is a global consulting and managed services provider formed in 2018 from the public sector practice of PwC. The company advises public and commercial clients on strategy, technology, risk management, and operations, focusing on energy, financial services, health, defense, and cybersecurity. With 18,000 professionals in over 60 offices worldwide, it delivers implementation support, managed services, and digital solutions to federal agencies, utilities, and Fortune 500 organizations. Guidehouse is majority-owned by Veritas Capital and partners with governments and businesses to address complex regulatory, operational, and innovation challenges.
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