With a unique blend of large firm resources and an entrepreneurial collaborative culture, Navigant/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 you're passionately motivated to make a difference and deliver exceptional work, we invite you to learn more about your career opportunities at www.guidehouse.com
Navigant Business Process Management unites the strengths of four category-leading companies to address the complexities of today's 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 and 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 EAPG's.
+ Knowledge and understanding of hospital charge description master coding systems and structures.
+ Hospital medical billing and auditing experience preferred.
+ 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 environment
**Navigant** 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.
Navigant 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.