Revenue Integrity Coding Specialist

Guidehouse

. Provide revenue cycle support services under the direction of the Director of Revenue Integrity .

Posted 11/5/2026full-timeRemote • United StatesMid-LevelSenior💰 $59,000 - $98,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Revenue Integrity processes, including ICD-10, CPT, and HCPCS coding, while ensuring compliance with Medicare, Medicaid, and third-party payer guidelines. Proficient in resolving claim edits and denials, with strong communication skills to support effective collaboration.

Highest-signal resume keywords

Revenue Integrity ExperienceICD-10 CodingCPT CodingAAPC CertificationMedicare Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

ICD-10 CodingCPT CodingHCPCS Level II CodingMedical Necessity DeterminationClaim Denial ResolutionCorrect Coding Initiatives (CCI)Medically Unlikely Edits (MUE)UB-04 BillingOutpatient Grouping SystemsHospital Charge Description Master

Soft Skills

Strong Verbal CommunicationWritten CommunicationInterpersonal SkillsTime Management

Tools & Technologies

Guidehouse METRIX℠ System

Certifications & Qualifications

AAPC CertificationAHIMA Certification

Industry Keywords

Revenue Cycle SupportBilling ComplianceThird-Party PayerHospital BillingOutpatient Setting

About the role

Key responsibilities & impact

Provide revenue cycle support services under the direction of the Director of Revenue Integrity
Review and timely resolve assigned Medicare and third-party payer accounts subject to pre-bill claim edits, hospital billing scrubber bill hold edits, and claim denials
Resolve assigned claims with Revenue Integrity pre-bill edits and specific Revenue Integrity Hold Codes in the hospital billing scrubber
Resolve standard billing edits, including Correct Coding Initiatives (CCI), Medically Unlikely Edits (MUE), Medical Necessity edits, and other claim-level edits
Review clinical documentation and diagnostic results as needed to validate and apply ICD-10, CPT, HCPCS codes and associated coding modifiers
Resolve assigned Revenue Integrity-specific denials in the Guidehouse METRIX℠ system
Ensure coding and billing practices comply with Federal/State guidelines using authoritative information
Maintain current knowledge of Medicare, Medicaid, and third-party payer billing compliance guidelines and requirements
Perform other duties commensurate with skills and experience as determined by the Director of Revenue Integrity

Requirements

What you’ll need

High School Diploma (Relevant experience may be substituted for formal education)
5+ years of Revenue Integrity 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
Knowledge of current code bundling rules and regulations, 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
Strong verbal, written and interpersonal communication skills
Ability to produce accurate assigned work product within specified time frames
Hospital medical billing and auditing experience preferred as a nice-to-have
Associate's degree preferred as a nice-to-have

Benefits

Comp & perks

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
Flexible benefits package
Flexible work arrangement (100% remote)