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.
High School Diploma/GED (relevant experience may be substituted for formal education) 1+ years of medical coding experience AAPC CPC or AHIMA CCS 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
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
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace. Benefits include: 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