[Hiring] Revenue Integrity Coding Billing Supervisor @Guidehouse

Role Description

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.

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.
• Resolve standard billing edits such as:
  • Correct Coding Initiative (CCI)
  • Medically Unlikely Edits (MUE)
  • Medical Necessity edits
  • Other claim level edits as assigned
• Review clinical documentation and diagnostic results as appropriate to validate and apply applicable ICD-10, CPT, HCPCS codes and associated coding modifiers.
• Resolve assigned claims with Revenue Integrity specific denials in the Guidehouse METRIX℠ system.
• Ensure coding and billing practices are in compliance with Federal/State guidelines by utilizing various types of authoritative information.
• Maintain current knowledge of Medicare, Medicaid, and other third party payer billing compliance guidelines and requirements.
• Collaborate with other departments and professionals within the organization to effectively resolve any revenue integrity issue that may arise.
• Supervise and train RI staff to ensure that the hospital receives appropriate reimbursement and conforms to applicable guidelines and regulations.
• Develop and maintain Client Policies and Procedures specific to the project.
• Act as liaison between RI teams and client and relay expectations in a clear, organized manner.
• Review all new RI team member's work to ensure compliance with facility guidelines and quality standards.
• Monitor and track daily staff productivity, workload, and workflows to ensure turnaround standards are met.
• Determine staffing needs and adjust schedules to support workflow needs to meet goals.
• Complete employee timesheets and time off in payroll system.
• Assist in interviewing and hiring qualified RI staff and ensure minimum requirements are met.
• Maintain ongoing dialogue with client and RI team by participating in monthly conference calls.
• Provide daily support to RI team to resolve problems and respond to questions relating to the facility.
• Evaluate Team Member job competency, identifying strengths & weaknesses and provide ongoing training and development.

Qualifications

• 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.
• Proficiency in determining accurate medical codes for diagnoses, procedures and services performed in the outpatient setting.
• Knowledge of current code bundling rules and regulations along with proficiency on issues regarding compliance, and reimbursement under outpatient grouping systems.
• 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.

Requirements

• Hospital medical billing and auditing experience preferred.

Benefits

• 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