PFRT Rev Integrity Specialist - REMOTE

UMass Memorial Health • Worcester, MA

118d

About The Position

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. This position serves as a Charge Generation Tracker (CGT) and regulatory gatekeeper to ensure compliance with coding and billing guidelines. The role involves reviewing assigned edits, providing regulatory support, and acting as a primary resource for coding questions and revenue enhancement.

Requirements

• Associate’s degree.
• Certification in Professional Coding (CPC).
• EPIC Credentialed in Ambulatory within 12 months of hire date.
• Three to five (3-5) years of work experience related to professional billing and coding.
• Knowledge of industry standard practices, including CPT/HCPCS codes and third-party reimbursement policies.
• Strong interpersonal and communication skills.
• Detail oriented with strong analytical skills.

Responsibilities

• Serves as a gatekeeper to ensure compliance with third party regulatory and coding billing guidelines.
• Collaborates with clinical/ancillary departments to facilitate proper use of CGT files.
• Ensures system-wide compliance with federal, state, and local regulations regarding charge codes.
• Reviews all assigned edits within prescribed timeframe and routes to appropriate owner for resolution.
• Provides support and guidance to clinical and RI/Charge Capture staff to resolve outstanding edits.
• Monitors daily edits reports and alerts clinical departments of delinquencies.
• Utilizes subject matter knowledge to support proper interpretation and analysis of performance reports.
• Ensures the CGT structure supports effective capture of all chargeable services.
• Develops and conducts educational courses and seminars on professional documentation, coding, and billing.
• Performs quality audits and reviews of focused patient accounts to identify improvement opportunities.

Benefits

• Signing bonus may be available.
• Comprehensive health benefits.
• 401k plan.
• Paid time off.
• Professional development opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees