Revenue Integrity Coding- Billing Specialist- Remote Location

Company: Guidehouse
Location: Boulder
Posted on: February 16, 2020

Job Description:

With a unique blend of large firm resources and an entrepreneurial collaborative culture, Guidehouse is where your purpose, passion, and expertise transform organizations. Guidehouse is a leading global provider of consulting services to the public and commercial markets with broad capabilities in management, technology, and risk consulting. We help clients address their toughest challenges with a focus on markets and clients facing transformational change, technology-driven innovation and significant regulatory pressure. Across a range of advisory, consulting, outsourcing, and technology/analytics services, we help clients create scalable, innovative solutions that prepare them for future growth and success. Headquartered in Washington DC, the company has more than 7,000 professionals in more than 50 locations. If youre passionately motivated to make a difference and deliver exceptional work, we invite you to learn more about your career opportunities at www.guidehouse.comInterested in working with talented people to help develop innovative solutions to some of societys most complex and challenging problems? We are Guidehouse, a leading consulting firm serving the public sector and commercial clients with specialized capabilities in strategy, technology, and risk management. You may not yet know our name, but we have a rich history. Guidehouse is a combination of PwCs former public sector practice and Navigants deep expertise in energy, financial services and healthcare.We offer an exciting, fast-paced environment that fosters intellectual growth and rewards individuals based on impact, not tenure. Our firm is at the forefront of an emerging model solving complex problems that stretch across government and private companies, affording our people the opportunity to be on the cutting edge of the consulting profession. By focusing on markets facing transformational change, technology-driven innovation, and significant regulatory pressure, our employees also develop and deploy world class knowledge and problem solving that leads to breakthrough solutions.Our healthcare segment is comprised of consultants, former provider administrators, clinicians, and other experts with decades of strategy, operational/clinical consulting, managed care services, digital health, revenue cycle management, and outsourcing experience. Professionals collaborate with hospitals and health systems, physician enterprises, payers, government, and life sciences entities, providing performance improvement and business process management solutions that help them meet quality and financial goals. You will make an immediate impact from day one, working with a team to provide end-to-end solutions. We dont simply put band-aids on our clients issues, we are working side-by-side with them. Are up for the challenge?Business Process Management unites the strengths of four category-leading companies to address the complexities of todays healthcare system. We design, develop and implement integrated, patient-centered solutions for sustained improvements in performance and profitability, working collaboratively across a spectrum of customers that encompasses hospitals, health systems, physician practice groups and payers.As a member of the Navigant Comprehensive Revenue Cycle Management (CRCM) team, the Revenue Integrity Coding Billing Specialist combines subject matter expertise with Navigant technology solutions to investigate, track and resolve health care claim billing errors and denials.This position contributes to the mission of the Revenue Integrity Program to help improve compliance with government, managed care and other third-party payer billing and reporting requirements. Through collaboration between the CRCM project team and client stakeholders, the Revenue Integrity Specialist contributes to continuous process improvements to meet and/or exceed established Revenue Integrity Key Performance Indicators (KPI).

• Demonstrates the ability to make sound, productive, and ethical decisions in the performance of assigned duties.
• Demonstrates a commitment to quality and excellence.
• Contributes to team effort by remaining flexible and open minded, maintaining cooperative working relationships, sharing resources and information, and assisting co-workers in time of need.
• Complies with Navigant and CRCM client policies and procedures.
• Promotes client customer service through active communication, understanding their needs and concerns, and providing resolution with tact, diplomacy and sensitivity.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. 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 Navigant 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.
  • Associate Degree or equivalent of 5 years job related 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 EAPGs.
  • Knowledge and understanding of hospital charge description master coding systems and structures.
  • Hospital medical billing and auditing experience.
  • Strong verbal, written and interpersonal communication skills.
  • Word/Excel proficient.
  • Ability to produce accurate, assigned work product within specified time frames.
  • Strong conceptual, as well as quantitative and qualitative analytical skills
  • Work as a member of a team as well as be a self-motivator with ability to work independently
  • Constantly operates a computer and other office equipment to coordinate work
  • Regularly uses close visual acuity and operates computer equipment to prepare and analyze and transmit data
  • Generally works in an office environmentAdditional Requirements
    • This position requires successful completion of a background check and employment verification.
    • The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, 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.If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.Rewards and BenefitsGuidehouse 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.

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