Revenue Integrity Coding Billing Specialist
Core
Review and resolve Medicare and third-party payer claims subject to pre-bill edits, billing scrubber holds, and denials to ensure revenue cycle support.
Role type
Revenue Integrity Coding Billing Specialist
Builds
Cleaned claims and resolved denials for hospital outpatient services
Domain
Healthcare billing and revenue integrity
Required skills
ICD-10, CPT, HCPCS Level II coding, medical necessity determination, Medicare/Medicaid/UB-04 billing compliance, CCI/MUE edit resolution, hospital charge description master (CDM) knowledge
Preferred skills
Hospital medical billing auditing experience, Associate's degree
Technologies
Guidehouse METRIX, hospital billing scrubber systems
Responsibilities
Resolve assigned claims with Revenue Integrity pre-bill edits and hold codes; Review clinical documentation to validate and apply applicable codes and modifiers; Resolve claim denials in the Guidehouse METRIX system; Maintain knowledge of payer billing compliance guidelines and code bundling rules
Seniority
Mid-level, hands-on IC
