Manager Professional Billing Revenue Integrity

Finance & Revenue Cycle Worcester, Massachusetts


Position at UMass Memorial Health

Everyone Is a Caregiver.

At UMass Memorial Health Care, Everyone is a Caregiver regardless of title. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health care system of Central and Western Massachusetts, and a place where we can help you build the career you deserve. We are more than 14,000 employees, working together as one health care system. And everyone, in their own unique way, plays an important part, everyday.

Requisition #: 215045
Title: Manager, Professional Revenue Integrity
Department:  Professional Billing
Location: UMass Memorial Health Care – 306 Belmont St, Worcester, MA
Posting Date: June 9, 2021
Shift: Days
Status: Exempt
Hours: 40
Shift Length: 8 hours 

Position requires candidate be available for training/meetings to accommodate physician schedules as needed.  This may be early morning or evening as required.
Position Summary:
Manages the process of updating Charge Generation Tracker (CGT) and regulatory gatekeeping to ensure compliance with coding and billing guidelines. Manages the professional staff ensuring all assigned edits are understood, routed and resolved within prescribed timeframe. Manages the provision of regulatory (coding and billing) support to clinical charge capture specialists to address CGT, coding, charge capture and billing questions. Ensures accurate and timely response is maintained as a primary resource for providers, clinical and administrative staff for coding questions and research related to revenue enhancement and correct coding. Assures positive interpersonal relationships with providers and colleagues is maintained.
Major Responsibilities: 
  • Manages the regular and annual CGT updates to ensure codes are compliant with third party regulatory and coding billing guidelines and reflect clinical practice.
  • Assigns Professional Fee Resource Team Revenue Integrity (PFRT RI) to educate clinical / ancillary departments to facilitate proper use of CGT files as well as oversight of 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 by PFRT RI.
  • Ensures all assigned edits are reviewed within prescribed timeframe and route to appropriate owner for resolution.
Position Qualifications:

CPC Certification; EPIC Credentialed  (i,e, Ambulatory, Kaleidoscope, Cupid, Inpatient) within 12 months

  • Bachelor’s degree in business, health care administration or related field.
  • American Association of Professional Coder Certification (AAPC).
  • EPIC Credentialed in Ambulatory within 12 months of hire date.


  • A minimum of 2 years of work experience managing staff related to professional billing, coding and provider training.
  • 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.

Standards of Respect: