Revenue Integrity Coding & Billing Specialist - Remote
Home Office: Dallas, TX
Job Family:
General Coding
Travel Required:
Clearance Required:
Job Posting
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 timely 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. This position is 100% remote.
Daily duties for this position include:
Responsible for the daily resolution of assigned claims with applicable Revenue Integrity pre-bill edits and/or specific Revenue Integrity Hold Codes in the hospital billing scrubber. Tasks associated with this work include resolving standard billing edits such as:
Correct Coding Initiative (CCI)
Medically Unlikely Edits (MUE)
Medical Necessity edits
Other claim level edits as assigned.
As needed, review clinical documentation and diagnostic results as appropriate to validate 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 are in compliance with Federal/State guidelines by utilizing various types of authoritative information.
Maintains current knowledge of Medicare, Medicaid, and other third-party payer billing compliance guidelines and requirements.
Other duties commensurate with skills and experience as determined by the Director of Revenue Integrity.
What You Will Need:
Revenue Integrity Coding & Billing Specialist - Remote (Level 3)
High school diploma and 3 years of prior relevant 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. 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 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.
Ability to produce accurate, assigned work product within specified time …
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100% remote None
Benefits/Perks100% Remote 401(k) Retirement Plan Basic Life & Supplemental Life Childcare Program Company paid holidays Corporate Sponsored Events & Community Outreach Dental Emergency Back-Up Childcare Program Employee Referral Program Flexible Spending Accounts Fully remote Health savings account Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts Medical Medical, Rx, Dental & Vision Insurance Paid holidays Parental leave Personal and Family Sick Time Personal and Family Sick Time & Company Paid Holidays Rx Sick time Skills Development & Certifications Tuition reimbursement Tuition Reimbursement, Personal Development & Learning Opportunities Variable Incentive Bonus Vision Vision Insurance
Tasks- Reporting
- Review clinical documentation
- Review clinical documentation and diagnostic results
- Training
Auditing Billing compliance Clinical Documentation Coding CPT HCPCS ICD ICD-10 Medical Billing Medical Coding Organizational Training
Experience3 years
Education Certifications TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9