Revenue Integrity Coding Billing Specialist (remote)

📋 Description

• • The Revenue Integrity Coding Billing Specialist provides essential revenue cycle support by reviewing and resolving Medicare and third-party payer accounts subject to pre-bill edits, billing scrubber holds, and claim denials, ensuring accurate and compliant billing practices.
• • Day-to-day responsibilities include resolving standard billing edits such as Correct Coding Initiatives (CCI), Medically Unlikely Edits (MUE), and medical necessity edits; reviewing clinical documentation to validate ICD-10, CPT, and HCPCS codes; and managing claim denials in the Guidehouse METRIX℠ system.
• • The role operates within Guidehouse’s Revenue Integrity team under the direction of the Director of Revenue Integrity, supporting accurate reimbursement and compliance with federal and state billing regulations in a fully remote environment.
• • This position offers the opportunity to deepen expertise in hospital outpatient coding, reimbursement systems (such as Medicare OPPS and EAPG), and compliance with evolving healthcare billing regulations while contributing to financial integrity and operational efficiency.