Remote Outpatient Coder - Medical Necessity

at Guidehouse in Little Rock, Arkansas, United States

Job Description


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 and navigate significant regulatory pressures with a focus 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 prepare our clients for future growth and success. The company has more than 10,000 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:


The Remote Outpatient Coder- Medical Necessity will review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10 Diagnosis codes, along with CPT codes as defined for the service type, for coding. Demonstrates the ability to perform quality diagnosis coding on ancillary, radiology, and clinic coding. Demonstrates the ability to review a medical necessity denial, review the documentation, and locate diagnosis appropriate for medical necessity coverage according to payer and facility guidelines. Coder will be responsible for adding diagnosis codes for coverage and performing rebill of accounts. Coder will demonstrate the ability to read Biller’s notes and work denial accordingly. 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, and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets. This is a 100% full time remote position. Duties and Responsibilities:

+ Demonstrates the ability to perform quality diagnosis and surgical CPT coding on coding on ancillary, clinic, and radiology outpatient records. No HCPCS coding will be porvided by the coder.

+ Reviews the medical necessity denial provided, reviews documentation, adds diagnosis that meeet the medical necessity standard for coverage that is confirmed by the payer to be accurate for coverage.

+ Coder will only be adding diagnosis codes for medical necessity coding.

+ Maintains a working knowledge of ICD-9-CM/ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing.

+ Assures that all services documented in the patient’s chart are coded with appropriate ICD-9/ICD-10 and CPT When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards.

+ Achieves and maintains 95% accuracy in coding while maintaining a high level of productivity. Accuracy will be monitored during monthly reviews either within the facility.

+ Ability to maintain average productivity standards as follows: medical necessity at 10 charts per hour. (These productivity standards are Guidehouse’ general expectations and are subject to change based upon Guidehouse client agreements and/or other factors as determined by management. Notification of expected productivity will be conveyed by Management prior to assignment of a client project).

+ Coder downtime must be reported immediately to the administrative staff to ensure turn around is met.

+ Responsible for working directly with the IQC staff to ensure quality standards are being met for each facility.

+ Provides accurate answers to physician’s/hospitals coding and/or billing questions within 8 hours of request.

+ Responsible for coding or pending every chart placed in their queue within 24 hours.

+ It is the responsibility of the coder to notify administrative staff in the event they cannot meet the 24 hour turn around standard.

+ Quality reports must be reviewed, and necessary corrective action plan should be communicated to the IQC manager within five working days of receipt of the monthly quality report.

+ Coders are responsible for checking the Guidehouse email system at least every two hours during coding session.

+ Coders must maintain their current professional credentials while working for Guidehouse.

+ Coders are responsible for becoming familiar with the Guidehouse coding website and using the information contained in the website as a daily tool to correctly code and abstract for each facility.

+ Coders are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy).

+ Coders are responsible for maintaining patient privacy at all times (reference company handbook policy compliance section 105).

+ Coders are responsible for signing a confidentiality statement.

+ It is the responsibility of each coder to review and adhere to the coding division policy and procedure manual content.

+ Works well with other members of the facilities coding and billing team to ensure maximum efficiency and reimbursement for properly documented services.

+ Communicates problems or coding principle discrepancies to their supervisor immediately .

+ Communication in emails should always be professional (reference e-mail policy).


+ Must hold one of the following credentials: RHIA, RHIT, CCS, COC, CPC

+ Must have 3+ years coding outpatient medical necessity hospital specialties experience

+ Must have minimum 3+ years of ICD-10 and CPT coding experience

+ Abide by all client policies and procedures

+ Abide by all Guidehouse policies and procedures

+ Must have experience working in systems such as EPIC, Cerner, Next Gen, Allscripts or other EHR.

+ Personal responsibility, respect for others, innovation through teamwork, dedication to caring and excellence in customer service

Preferred Qualifications:

+ Strong medical necessity denial experience with diagnosis adn CPT coding background for ancillary, clinic and radiology in the hospital setting

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.


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 . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommoda To view full details and how to apply, please login or create a Job Seeker account
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Job Posting: JC187398475

Posted On: Jul 09, 2021

Updated On: Sep 22, 2021