Revenue Integrity Specialist

Required Skills & Experience

Must Haves -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

Nice to Have Skills & Experience

-Previous Revenue Integrity experience -Epic Ambulatory experience or certification -Experience conducting coding audits, provider reviews, or documentation improvement initiatives -Physician office management, clinical education, or provider-support experience combined with coding expertise

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.