Professional Billing & Coding Education Specialist

C999 UMass Memorial Health Care, Inc.; Worcester (MA); Remote; USD 64,000 - 115,000; Full time

Benefits offered by this job

Signing bonus

Job summary

UMass Memorial Health is seeking a Charge Generation Tracker (CGT) to ensure accurate coding and billing, review edits, and support clinical charge capture staff. The role requires strong knowledge of CPT/HCPCS, regulatory guidelines, and collaboration across departments to maintain compliance.

Based in Worcester, MA, this full-time position offers a day shift with standard hours and potential signing bonus eligibility.

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.
• Knowledge of coding and billing requirements based on third party publications, including Blue Shield, Medicare, Medicaid, commercial insurers and HMOs / PPOs.
• Strong interpersonal and communication skills required. Ability to speak and present in front of groups required.
• Detail oriented, strong analytical skills with the ability to multi task and prioritize required.
• A working knowledge of Microsoft Office applications, 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 and reflect clinical practice.
• Collaborates with clinical / ancillary departments to facilitate proper use of CGT files as well as synchronization of preference lists and orders in IT applications.
• Ensures system wide compliance with federal, state and local regulations with regard to charge codes and related information in the CGT.
• Ensures standardized CGT request processes are followed.
• 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.
• Provides regulatory (coding and billing) support to clinical charge capture specialists to address CGT, coding, charge capture and billing questions.
• Utilizes subject matter knowledge to support proper interpretation and analysis of performance report(s).
• Utilizes reporting and data analysis in combination with standard benchmarks and criteria to identify and follow-up on potential revenue integrity issues.
• Ensures the CGT structure supports effective capture of all chargeable services based on a thorough knowledge of the regulatory requirements, IT applications and charge capture processes.
• Provides subject matter knowledge related to the CGT for clinical departments, revenue cycle team, finance, compliance and administrative staff.
• Provides accurate feedback and documentation to support educational needs.
• Develops and conducts educational courses and seminars focusing on professional documentation, coding and billing for physicians, clinicians, administrative staff and Professional Billing Central Billing Office (PBCBO) staff.
• Develops training programs and supporting materials relative to physician coding and billing guidelines and protocols to ensure that specific areas of need are addressed and that all materials comply with applicable rules and regulations.
• Participates in PBCBO staff training on coding and billing guidelines.
• Monitors CMS and applicable third party coding and billing publications, and abstracts key information relative to established coding and billing policies and procedures for distribution to UMMMG stakeholders (clinical, administrative, compliance, PFS, finance).
• Researches third party coding and billing guidelines and ensures timely and accurate compliance with federal, state, local payer requirements as well as UMMMG contracts specific to charging, coding, bundling and unbundling, modifier reporting requirements.
• Leads annual review process by providing updates regarding CPT, CMS regulatory updates, professional society publications (e.g., ASA) for clinical, administrative, compliance, revenue cycle, and finance.
• Performs quality audits and reviews of focused patient accounts to identify improvement opportunities in clinical documentation, charge capture and coding.
• Provides audit feedback to key clinical and revenue cycle stakeholders for continuous improvement.
• Monitors downtime forms for each billing area.
• Collaborates with clinical charge capture analyst to ensure that downtime procedure is maintained.

Skills

CPT/HCPCS knowledge

Billing & coding experience

Interpersonal communication

Detail-oriented

Microsoft Office skills

Regulatory research

Education

Associate’s degree

Certified Professional Coder (CPC)

EPIC Credentialed in Ambulatory

Tools

EPIC

Job description

UMass Memorial Health is seeking a Charge Generation Tracker (CGT) to ensure accurate coding and billing, review edits, and support clinical charge capture staff. The role requires strong knowledge of CPT/HCPCS, regulatory guidelines, and collaboration across departments to maintain compliance.

Based in Worcester, MA, this full-time position offers a day shift with standard hours and potential signing bonus eligibility.