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.