Revenue Integrity Specialist (Professional Billing)
Position Overview
Serves as a Charge Generation Tracker (CGT) and regulatory resource to ensure compliance with coding and billing guidelines. Acts as a primary resource for providers and staff, supporting revenue integrity, charge capture, and coding accuracy.
Position Details
Location: Worcester, MA (Primarily Remote)
Schedule: Monday – Friday, 8:00 AM – 5:00 PM
Employment Type: Full-Time, Exempt
Key Responsibilities
- Ensure Charge Generation Tracker (CGT) compliance with regulatory and coding guidelines
- Review billing edits and route for resolution
- Provide coding and billing guidance to clinical and administrative teams
- Analyze data to identify revenue integrity opportunities
- Collaborate with departments to optimize charge capture workflows
- Develop and conduct training on coding and documentation
- Monitor CMS and payer updates and ensure compliance
- Perform audits to improve documentation and coding accuracy
- Support reporting, benchmarking, and performance analysis
Qualifications
Required:
- Associate’s degree
- Certified Professional Coder (CPC)
- EPIC Ambulatory certification within 12 months
- 3–5 years of professional billing and coding experience
- Strong knowledge of CPT/HCPCS and payer regulations
- Strong analytical and communication skills
- Proficiency in Microsoft Office
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