Job Family:

Travel Required:

Clearance Required:

Position Summary

As a member of the Guidehouse Comprehensive Revenue Cycle Management (CRCM) team, the Revenue Integrity Coding Billing Supervisor combines subject matter expertise with Guidehouse 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 Manager contributes to continuous process improvements to meet and/or exceed established Revenue Integrity Key Performance Indicators (KPI).

What You Will Do:

Under the direction of the Director of Revenue Integrity, the Revenue Integrity Coding Billing Supervisor 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 Guidehouse 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.
• Collaborate with other departments and professionals within the organization to effectively resolve any revenue integrity issue that may arise
• Supervises and trains RI staff to ensure that the hospital receives appropriate reimbursement and conforms to applicable guidelines and regulations. Ensures the accuracy and timeliness of the RI process
• Develops and maintains Client Policies and Procedures specific to the project.
• Acts as liaison between RI teams and client and relays expectations in a clear, organized manner to ensure accurate and efficient job performance.
• Reviews all new RI team member's work to ensure compliance with facility guidelines and quality standards before is released to perform.
• Monitors and tracks daily staff productivity, workload, and workflows to ensure turnaround standards are met.
• Determines staffing needs and adjust schedules to support workflow needs to meet goals.
• Completes employee timesheets and time off in payroll system
• Assists in interviewing and hiring qualified RI staff and ensure minimum requirements are met.
• Maintains ongoing dialogue with client and Ri team by participating in monthly conference calls to communicate issues, recommend process improvements and ensure client expectations are being met
• Provides daily support to RI team to resolve problems and respond to questions relating to the facility
• Evaluates Team Member job competency, identifying strengths & weaknesses and provides ongoing training and development.

What You Will Need:

• University degree or equivalent of 5 years job related experience (Relevant experience may be substituted for formal education or advanced degree)
• Must have three years management experience
• AAPC or AHIMA coding certification required.
• 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 EAPG’s.
• Knowledge and understanding of hospital charge description master coding systems and structures.
• Strong verbal, written and interpersonal communication skills.
• Word/Excel proficient.
• Ability to produce accurate, assigned work product within specified time frames.

What Would Be Nice to Have:

• Hospital medical billing and auditing experience preferred.

#LI-DNI

What We Offer:

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