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Overview

Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting. By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success. The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit www.guidehouse.com.

Responsibilities

The Coding Denial Specialst will review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10 Diagnosis codes, along with CPT/HCPCS codes as defined for the service type, for coding, billing, internal and external reporting, research as required, and regulatory compliance. Under the direction of the coding manager—the coder should accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, CMS/MAC rules and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets. The coder scope may involve reviewing coding related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines. This position is 100% remote.

Essential Job Functions

• Computer Literacy

• Good working knowledge of Anatomy and Physiology as well as Medical Terminology

• Advanced knowledge of CMS/MAC guidance, Coding Skills, ICD-10-CM and CPT

• Ability to analyze Provider documentation and assign codes accurately

• Excellent verbal and written Communication Skills

• Strong knowledge and application of Government and other payer guidelines as they relate to compliant coding.

• Ability to analyze coding denial reason codes, review documentation and respond appropriately regarding what is needed to resolve the denial issue.

• Experience creating appeal letters as appropriate and communicating with billing teams either within Guidehouse or within a Client organization.

• High level of Accuracy and Productivity. Meets or exceeds standards consistently

• Ability to work independently

• HIPAA compliant work stations

• Strong working knowledge of Protected Health Information

• Maintains professional credentials at all times

• Organizational Skills

• Knowledge of Microsoft Word and Excel

Qualifications

• Minimum 3-5 years Coding Denials Specialists• Must hold one of the following credentials: CCS, CPC, RHIT, RHIA• EPIC experience• Must maintain credential throughout employment• Must be able to work independently, multi-task well and interface with all levels of personnel as well as clients• Excellent verbal, written and interpersonal communication skills• Advanced knowledge of Excel, Word and PowerPoint• Strong Working Knowledge & experience with Federal & State Coding regulations and Guidelines

• 3-5 years of working coding denials and coding edits

• Assign ICD 10 diagnosis• Assign CPT professional codes• ED E/M levels• Injection and Infusion coding• Medical necessity for coding and RI• CCI Edits• Revenue Codes• Procedure mismatch• Modifier usage• Edit and denial experience

Additional Requirements

The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.

Candidates from Eastern Standard Time, Central Standard Time, and Pacific Standard Time Zones as well as candidates from Arizona, New Mexico and Utah will be considered for this position.

Disclaimer

About Guidehouse

Guidehouse 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.

Guidehouse 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.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Rewards and Benefits

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 and Adoption Assistance

• 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

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