HYBRID Revenue Integrity Specialist - 259306

Medix™; Worcester (MA); On-site; USD 90,000 - 120,000; Full time

Job summary

Medix is seeking a CGT Specialist to ensure regulatory compliance for coding, billing, and third-party guidelines across the system. The role acts as the primary resource for clinical staff, providers, and administration on coding and billing matters.

You will lead CGT updates, perform audits, and develop training materials to improve documentation and charge capture. This position supports revenue integrity and requires EPIC proficiency and CPC certification.

Qualifications

• CPC certification required.
• Proficient in EPIC and Microsoft Office.
• 3-5 years professional billing and coding experience.
• Experience with OB/GYN billing and coding.
• Strong knowledge of CPT/HCPCS codes and payer policies.
• Ability to create and present reports to physicians.

Responsibilities

• Maintain CGT in compliance with federal, state and payer regulations and synchronize with IT applications.
• Review and resolve billing/coding edits within prescribed timeframes and coordinate with staff for resolution.
• Provide regulatory support and guidance on coding and billing to providers and staff.
• Develop and deliver educational courses on coding and billing guidelines.
• Lead annual CPT/CMS reviews and perform audits of patient accounts.

Skills

Billing experience 3-5 yrs

OB/GYN billing

CPT/HCPCS knowledge

Third-party policies

Report creation

Education

CPC certification

Tools

EPIC

Microsoft Office

Job description

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.

Key Responsibilities

• 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 timeframes, 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.

Requirements

• 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

Schedule/Shift

Monday-Friday 8am-5pm (EST)