HYBRID Revenue Integrity Specialist

Serve as a critical Charge Generation Tracker (CGT) Specialist and regulatory gatekeeper, ensuring strict compliance with all coding, billing, and third-party guidelines. This role is essential for revenue integrity and correct charge capture across the system. You will act as the primary resource for clinical staff, providers, and administration on coding and billing regulatory matters.

• Regulatory Compliance & CGT Management:
  Maintain and update the CGT in compliance with federal, state, and payer regulations, ensuring accurate reflection of clinical practice and proper synchronization with IT applications.
• Edit Review & Resolution:
  Review and resolve assigned billing/coding edits within prescribed time frames, routing issues to appropriate owners and collaborating with clinical/charge capture staff for resolution. Monitor daily edit reports and address delinquencies.
• Expert Support & Resource:
  Provide expert regulatory support, guidance, and research on coding, billing, and charge capture to providers, clinical charge capture specialists, and administrative staff. Act as the primary subject matter expert for the organization.
• Education & Training:
  Develop and conduct educational courses, seminars, and training materials for physicians, clinicians, and billing staff on professional documentation, coding, and billing guidelines.
• Audit & Monitoring:
  Lead annual regulatory reviews (CPT, CMS updates) and perform quality audits of patient accounts to identify opportunities for improvement in documentation, charge capture, and coding. Monitor key coding and billing publications for timely compliance.

• CPC certification
• EPIC
• 3-5 years of experience in professional billing & coding
• Experience with OB/GYN Billing & Coding Experience
• Knowledge of CPT / HCPCS codes and third-party reimbursement policies
• Working knowledge of Microsoft applications; ability to create and present reports to physicians

Monday-Friday 8am-5pm (EST)