Billing Compliance and Revenue Optimization Specialist
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Job Description
Specialist role focusing on compliance and revenue optimization for healthcare billing. Responsible for program development and financial modeling in provider-based billing.
Responsibilities:
- Ensure organizational compliance, audit readiness, revenue integrity, and operational effectiveness
- Independently determine PBB eligibility for new and existing clinic locations
- Lead completion of CMS PBB Attestation for hospital-owned clinics and facilities
- Conduct scheduled annual compliance reviews
- Validate accuracy of PECOS enrollment for hospital facilities
- Monitor regulatory updates and communicate changes to stakeholders
- Conduct financial modeling for PBB conversions
- Analyze expected vs. actual revenue performance
- Maintain a master registry of all facility locations including PBB status
Requirements:
- Bachelor's degree in healthcare administration, business, finance, or related field, or equivalent experience
- Minimum 5 years of experience in revenue cycle, reimbursement, or compliance within a healthcare environment
- Demonstrated experience interpreting and implementing federal regulations
- Experience conducting root cause analysis and performance improvement activities
- Experience conducting audits of revenue cycle workflows and billing system build to ensure compliance with regulations
- Strong analytical skills
- Experience working with Epic
- Experience with Microsoft Word, Excel, PowerPoint, Teams
- Exceptional written and verbal communication skills
Benefits:
- Health insurance
- Retirement plans
- Flexible work arrangements
- Paid time off
- Professional development
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