About this role

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

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

Billing Compliance and Revenue Optimization Specialist

Key skills