Revenue Integrity Specialist

Top Prospect Group; Boston (MA); Hybrid; USD 80,000 - 110,000; Full time

Job summary

Top Prospect Group in Worcester, MA is seeking a Revenue Integrity Specialist (Professional Billing) to serve as a CGT and regulatory resource, ensuring coding and billing compliance. This role supports revenue integrity, charge capture, and coding accuracy across clinical and administrative teams.

Location: Worcester, MA (Primarily Remote); Monthly onsite presence is required. Schedule: Mon-Fri, 8:00 AM–5:00 PM, Full-Time exempt status.

Qualifications

• Associate's degree required.
• Certified Professional Coder (CPC) required.
• EPIC Ambulatory certification within 12 months.
• 3–5 years of professional billing and coding experience.
• Strong knowledge of CPT/HCPCS and payer regulations.
• Strong analytical and communication skills.
• Proficiency in Microsoft Office.

Responsibilities

• Ensure CGT compliance with regulatory and coding guidelines.
• Review billing edits and route for resolution.
• Provide coding and billing guidance to clinical and administrative teams.
• Analyze data to identify revenue integrity opportunities.
• Collaborate with departments to optimize charge capture workflows.
• Develop and conduct training on coding and documentation.
• Monitor CMS and payer updates and ensure compliance.
• Perform audits to improve documentation and coding accuracy.
• Support reporting, benchmarking, and performance analysis.

Skills

Analytical skills

Communication skills

CPC certification

CPT/HCPCS knowledge

Microsoft Office

Education

Associate's degree

Tools

EPIC Ambulatory

Microsoft Office

Job description

Revenue Integrity Specialist (Professional Billing)

Position Overview

Serves as a Charge Generation Tracker (CGT) and regulatory resource to ensure compliance with coding and billing guidelines. Acts as a primary resource for providers and staff, supporting revenue integrity, charge capture, and coding accuracy.

Position Details

• Location: Worcester, MA (Primarily Remote)*
• Monthly onsite presence is required.
• Schedule: Monday - Friday, 8:00 AM - 5:00 PM
• Employment Type: Full-Time, Exempt

Key Responsibilities

• Ensure Charge Generation Tracker (CGT) compliance with regulatory and coding guidelines
• Review billing edits and route for resolution
• Provide coding and billing guidance to clinical and administrative teams
• Analyze data to identify revenue integrity opportunities
• Collaborate with departments to optimize charge capture workflows
• Develop and conduct training on coding and documentation
• Monitor CMS and payer updates and ensure compliance
• Perform audits to improve documentation and coding accuracy
• Support reporting, benchmarking, and performance analysis

Qualifications

• Required: Associate's degree
• Certified Professional Coder (CPC)
• EPIC Ambulatory certification within 12 months
• 3-5 years of professional billing and coding experience
• Strong knowledge of CPT/HCPCS and payer regulations
• Strong analytical and communication skills
• Proficiency in Microsoft Office #TPGHartford