UMass Memorial Medical Center · 4 months ago
Professional Billing- Coding/Education Specialist - REMOTE
United States
Full-time
Remote
Mid Level
3+ years expUMass Memorial Medical Center is a premier health system in Central Massachusetts, dedicated to exceptional patient care and academic excellence. They are seeking a Professional Billing-Coding/Education Specialist who will serve as a regulatory gatekeeper to ensure compliance with coding and billing guidelines while providing support and education to clinical and administrative staff.
Health CareMedical
Responsibilities
Serves as a gatekeeper to ensure that regular and annual CGT updates compliant 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
Complies with established departmental policies, procedures and objectives
Attends variety of meetings, conferences, seminars as required or directed
Demonstrates use of Quality Improvement in daily operations
Complies with all health and safety regulations and requirements
Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors
Maintains, regular, reliable, and predictable attendance
Performs other similar and related duties as required or directed
Qualification
Required
Associate's degree
Certification in Professional Coding. (CPC) Certified Professional Coder
EPIC Credentialed in Ambulatory within 12 months of hire date
Three to five (3-5) years of work experience related to professional billing and coding
Knowledge of industry standard practices, including 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
Company
UMass Memorial Medical Center
Umass Memorial Medical Center is the clinical partner of UMass Medical School and the largest health care system in Central Massachusetts. It is a sub-organization of UMass Memorial Health Care.
10001+ employees
H1B Sponsorship
UMass Memorial Medical Center has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (13)
2024 (19)
2023 (10)
2022 (10)
2021 (12)
2020 (10)
Funding
Current Stage
Late StageLeadership Team
Bruce Whyte
Chief Technology Officer
Bart Metzger
Senior Vice President and Chief Human Resources Officer
Recent News
2025-12-11
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