What You Will Do Review multi‑specialty inpatient and outpatient and clinical Charge Correction requests for ICD‑10, CPT and HCPCS coding for accuracy and make necessary corrections. Review LCD and NCD criteria and insurance billing guidelines. Report any changes as necessary to collections teams. Electronically file replacement claims and some payment posting as needed. M‑F onsite training for approx. 3‑6 months. After training hybrid with 90% being remote/working from home.
What You Will Need High School Diploma/GED (relevant experience may be substituted for formal education)
1+ years of medical coding experience
AAPC CPC‑A coding certification
Experience in ICD‑10, CPT and HCPCS Level II Coding
Ability to determine medical necessity of services provided and charged based on provider/clinical documentation
Knowledge, understanding and proper application of Medicare, Medicaid, and third‑party payer HCFA‑1500 billing and reporting requirements including resolution of CCI, MUE and Medical Necessity edits applied to claims
Ability to determine accurate medical codes for diagnoses, procedures and services performed in the emergency department, inpatient and outpatient settings. 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
Ability to use MS Excel
What Would Be Nice To Have 5 years’ experience in Revenue Integrity Coding and Billing
Knowledge and understanding of physician charge description master coding systems and structures.
Physician medical billing and auditing experience
Salary The annual salary range for this position is $38,000.00-$64,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.
Benefits Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account
Dental/Vision & Dependent Care Flexible Spending Accounts
Short‑Term & Long‑Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back‑Up Childcare Program
Equal Opportunity Employer Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
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