Billing & Coding Education Specialist - Regulatory & Revenue

UMass Memorial Health; Worcester (MA); Remote; USD 64,000 - 115,000; Full time

Job summary

UMass Memorial Health is seeking a Charge Generation Tracker to ensure compliance with coding and billing guidelines across the health system. You will review edits, support staff, and collaborate with departments to optimize revenue integrity and accurate charge capture.

The role requires 3–5 years in professional billing/coding, CPC certification, and EPIC Ambulatory credentialing. On-site work is required with potential travel; compensation details are shared during interviews.

Qualifications

• Three to five (3-5) years of work experience related to professional billing and coding.
• Knowledge of CPT/HCPCS codes and third-party reimbursement policies.
• Strong interpersonal and communication skills.
• Detail oriented with ability to multi-task and prioritize.
• Ability to develop reports and create presentations.

Responsibilities

• Serves as a gatekeeper to ensure CGT updates comply with third party regulatory and coding billing guidelines.
• Collaborates with clinical/ancillary departments to synchronize CGT files and IT applications.
• Ensures system-wide compliance with federal, state and local regulations for charge codes and CGT data.
• Follow standardized CGT request processes.
• Reviews edits within prescribed timeframes and routes to appropriate owner for resolution.
• Provides support to clinical and RI / Charge Capture staff to resolve edits.
• Monitors daily edits reports and alerts departments of delinquencies.
• Provides regulatory (coding and billing) support to clinical charge capture specialists.
• Uses SME knowledge to interpret performance reports and conduct analyses.
• Uses reporting and data analysis with benchmarks to identify revenue integrity issues.
• Ensures CGT structure captures all chargeable services based on regulatory requirements.
• Provides SME feedback to clinical and revenue cycle stakeholders.
• Develops and conducts educational courses on coding and billing for staff.
• Develops training materials for physician coding guidelines and protocols.
• Participates in PBCBO training on coding and billing guidelines.
• Monitors CMS and third party publications and disseminates updates.
• Researches third party guidelines to ensure compliance with payer requirements.
• Leads annual CPT/CMS update review for stakeholders.
• Performs quality audits of focused patient accounts for improvement opportunities.
• Provides audit feedback for continuous improvement.
• Monitors downtime forms for billing areas and maintains procedures.
• Collaborates to maintain downtime procedure with billing teams.

Skills

Interpersonal skills

Communication skills

Analytical skills

Detail oriented

Multitasking

Microsoft Office

Report creation

Presentation skills

Education

Associate's degree

CPC Certification

EPIC Ambulatory Credential

Job description

UMass Memorial Health is seeking a Charge Generation Tracker to ensure compliance with coding and billing guidelines across the health system. You will review edits, support staff, and collaborate with departments to optimize revenue integrity and accurate charge capture.

The role requires 3–5 years in professional billing/coding, CPC certification, and EPIC Ambulatory credentialing. On-site work is required with potential travel; compensation details are shared during interviews.