Revenue Integrity Specialist

Insight Global; Massachusetts; On-site; USD 85,000 - 120,000; Full time

Job summary

UMass Memorial is seeking a Revenue Integrity Specialist to partner with physicians and provider groups to ensure services are documented, coded, and billed accurately. You will act as a coding and documentation SME, conducting audits and guiding CPT/HCPCS and compliance questions on site.

You will develop training materials, lead presentations for single providers to large groups, and provide onsite support to improve coding accuracy, documentation quality, and revenue capture while reducing

Qualifications

• CPC certification is required.
• 3+ years of professional billing and coding experience, preferably in a physician/professional fee environment.
• Experience training, educating, presenting to, and influencing physicians/providers on coding and documentation best practices.
• Strong communication skills and confidence working directly with providers, including the ability to challenge inaccurate coding or documentation when necessary.
• Ability and willingness to provide onsite "at-the-elbow" support across UMass Memorial practices as needed.

Responsibilities

• Conduce coding audits to identify documentation and revenue integrity gaps.
• Develop training materials and educational programs.
• Lead presentations from one-on-one coaching to large physician groups.
• Provide onsite support to providers to improve coding accuracy and revenue capture and reduce billing risk.
• Research payer and regulatory requirements related to CPT, HCPCS, and documentation.

Skills

CPC Certification

Coding audits

Provider education

Onsite support

Communication skills

Job description

This individual will serve as a Revenue Integrity Specialist supporting physicians and provider groups across UMass Memorial's professional billing organization. Rather than spending the majority of their day coding, they will act as a coding and documentation subject matter expert, partnering directly with providers to ensure services are documented, coded, and billed accurately. They will conduct coding audits, identify documentation and revenue integrity gaps, research payer and regulatory requirements, and provide guidance on CPT, HCPCS, billing, and compliance-related questions.

A significant portion of the role is focused on physician education and support. This person will develop training materials, create educational programs, lead presentations ranging from one-on-one provider coaching sessions to large physician groups, and provide onsite "at-the-elbow" support when needed. They will work proactively with providers identified as coding outliers, helping improve coding accuracy, documentation quality, compliance, and revenue capture while reducing billing risk and potential payer take-backs.

Requirements:

• CPC (Certified Professional Coder) certification
• 3+ years of professional billing and coding experience, preferably in a physician/professional fee environment
• Experience training, educating, presenting to, and influencing physicians/providers on coding and documentation best practices
• Strong communication skills and confidence working directly with providers, including the ability to challenge inaccurate coding or documentation when necessary
• Ability and willingness to provide onsite "at-the-elbow" support across UMass Memorial practices as needed

Compensation:

Exact compensation may vary based on several factors, including skills, experience, and education.