Medical Coding, Reimbursement Specialist
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Job Description
Medical coding specialist supporting Guidehouse’s federal healthcare consulting programs. Developing and validating code sets, reimbursement rules, and claims-related workflows across clinical and analytics stakeholders.
Responsibilities:
- Develop, refine, and maintain CPT, HCPCS, ICD-10, modifier, revenue code, and ancillary service code groupings
- Support development of code sets representing episodes of care, treatment pathways, and healthcare services
- Research coding guidance, Medicare policies, reimbursement methodologies, and billing requirements
- Identify related, supporting, bundled, ancillary, add-on, and downstream services associated with diagnoses and procedures
- Validate code sets against Medicare requirements, fee schedules, reimbursement policies, NCCI edits, and coding standards
- Review provider billing practices and claims patterns to identify missing, duplicative, or inappropriate code relationships
- Document coding rationale, business rules, assumptions, exclusions, and validation findings
- Participate in coding reviews, clinical reviews, quality control activities, and stakeholder reviews
- Collaborate with clinicians, reimbursement SMEs, and analytics teams on code inclusion, exclusion, and grouping decisions
- Support governance processes, change requests, maintenance activities, and version control efforts
Requirements:
- 5+ years of experience in medical coding, reimbursement, payment integrity, auditing, compliance, revenue cycle, or claims operations
- Strong knowledge of CPT, HCPCS, ICD-10-CM, ICD-10-PCS, revenue codes, modifiers, Medicare reimbursement methodologies, claims adjudication, provider billing workflows, NCCI edits, and fee schedules
- Experience working within payer, provider, TPA, Medicare, Medicaid, TRICARE, Commercial, or Federal healthcare environments
- Ability to translate coding guidance and reimbursement requirements into operationally actionable code set recommendations
- Candidates should possess one or more of the following certifications: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA), Certified Risk Adjustment Coder (CRC), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified in Healthcare Compliance (CHC), Certified Emergency Department Coding Specialist (CEDC), Certified OBGYN Coding Specialist (COBGC), or Certified Orthopedic Surgical Coding Specialist (COSC)
- Preference will be given to candidates local to the Washington, DC metro area
- Travel required up to 25%
- Clearance required: Ability to Obtain Public Trust
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 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
- Student Loan PayDown
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community Outreach
- Emergency Back-Up Childcare Program
- Mobility Stipend
- Flexible benefits package
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