VCU Health System Authority is hiring a remote Provider-Based Billing Compliance and Revenue Optimization Specialist. You will be independently responsible for ensuring organizational compliance, revenue integrity, and operational effectiveness align with federal provider-based requirements.
What You'll Do
- Independently determine Provider-Based Billing eligibility for clinic locations through financial, administrative, and operational integration assessments.
- Lead completion of CMS Provider-Based Billing Attestations and ensure audit-ready documentation.
- Conduct scheduled annual compliance reviews to ensure continued adherence to CMS regulations.
- Monitor regulatory updates, assess organizational impact, and communicate changes to key stakeholders.
- Conduct financial modeling for Provider-Based Billing conversions and analyze expected vs. actual revenue performance.
- Develop recurring reports and dashboards to track financial performance trends.
- Facilitate a cross-functional Medicare HB Reconciliation Workgroup to resolve hospital billing issues.
- Act as the central liaison for the accuracy of Epic configuration requirements for Provider-Based Billing designation.
- Conduct routine audits to ensure correct logic utilization across all visits, providers, and departments.
- Test new clinic builds before go-live, including end-to-end revenue cycle testing.
- Serve as the escalation contact for Provider-Based Billing issues and lead cross-functional compliance efforts.
- Work closely with Credentialing and Enrollment teams to validate CMS PECOS enrollment.
- Maintain a master registry of all facility locations and ensure database consistency to prevent billing errors.
- Serve as the lead advisor for provider-based billing to leadership and key committees.
- Develop and deliver training about provider-based billing requirements across operational, clinical, finance, and revenue cycle teams.
What We're Looking For
- 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, performance improvement activities, and revenue cycle audits.
- Strong analytical skills, including financial analysis, variance investigation, and data interpretation.
- Experience working with Epic.
- Experience with Microsoft Word, Excel, PowerPoint, Teams.
- Exceptional written and verbal communication skills.
- Ability to translate complex rules into practical workflows.
- Strong critical thinking and problem-solving abilities.
- Comfort leading cross-functional initiatives with diverse teams.
- A proactive, self-directed, and highly organized work style.
Nice to Have
- Epic Certification in PB/HB, Prelude, Cadence, or Resolute.
Technical Stack
- Epic
- Microsoft Word
- Excel
- PowerPoint
- Teams
Team & Environment
Reports directly to the VCUH Revenue Cycle Optimization Director.
Work Mode
This is a remote position open to candidates in the following states: AL, AR, FL, GA, KS, KY, MD, MI, MO, MS, NC, OH, SC, TN, TX, VA, WV.
VCU Health System Authority is an EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.
