Senior Revenue Integrity Specialist (remote)

At Boston Children's Hospital, the quality of our care and the strength of our inclusive, collaborative work environment lies in the diversity of our people. With patients coming from local communities and more than 160 countries, we are committed to reflecting a wide range of cultures and experiences while opening doors of opportunity for every member of our team. Here, different talents pursue shared goals, voices are heard, and ideas are valued. Join us and discover how your unique contributions can change lives, yours included.

Position Summary / Department Overview
The Senior Revenue Integrity Specialist is a fully remote role that supports Boston Children's Hospital's surgical and clinical practices. This position helps improve financial outcomes by reviewing and strengthening the full revenue cycle from patient care to final billing to ensure accuracy, efficiency, and compliance.

This role requires strong analytical skills, a deep understanding of billing and coding regulations, and the ability to partner effectively across clinical and administrative teams. The Specialist serves as a subject matter expert, interpreting and implementing billing rules and compliance standards, and using data to recommend improvements that enhance performance across departments.

Key Responsibilities

• Evaluate and improve charging and coding structures in clinical departments to ensure accurate revenue capture and compliance with payer and government requirements.
• Identify process gaps that cause missed or delayed charges and implement solutions for timely, accurate billing.
• Collaborate with peers to manage and audit the Charge Description Master (CDM) with a focus on revenue cycle integrity.
• Review charging systems, encounter forms, and charge documentation to confirm accuracy and consistency.
• Analyze billing errors and denial data to determine root causes and develop corrective actions.
• Monitor and interpret changes to billing and coding regulations; adjust systems and workflows to maintain compliance.
• Develop and maintain revenue integrity policies, procedures, and training materials.
• Provide guidance and education to departments on accurate billing, coding, and reconciliation practices.
• Lead or support projects related to revenue integrity in collaboration with Compliance, Finance, Patient Financial Services, and Internal Audit.
• Develop quality audit programs and associated reports to track progress
• Mentor junior specialists, provide oversight on their work, and support professional development.

Minimum Qualifications

• Education: High school diploma required; bachelor's degree preferred.
• Experience: Minimum of five years in a hospital or healthcare billing environment.

Skills and Competencies

• Ability to review and interpret managed care contracts, billing guidelines, and reimbursement regulations
• Knowledge of federal and state rules governing coding and billing practices.
• Strong analytical and financial skills, including database management and report generation.
• Proven problem-solving ability with the capacity to resolve complex issues across teams.
• Comprehensive understanding of healthcare revenue cycle operations.
• Ability to meet deadlines and influence outcomes without direct supervisory authority.

Licensure / Certifications
Relevant professional certifications such as CPC, COC, AHIMA CCS, RN, RT, MT, RPH, or PMP are highly desirable.

Why Boston Children's Hospital
Boston Children's Hospital offers competitive pay and an exceptional benefits package, including flexible schedules, comprehensive health, dental, and vision insurance, child care and student loan subsidies, generous paid time off, a 403(b) retirement plan, pension, tuition and certification reimbursement, and transportation discounts.

At Boston Children's, you will experience the rewards of teamwork, innovation, and purpose, helping make a lasting difference in the lives of children and families everywhere.

The posted pay range is Boston Children's reasonable and good-faith expectation for this pay at the time of posting.

Any base pay offer provided depends on skills, experience, education, certifications, and a variety of other job-related factors. Base pay is one part of a comprehensive benefits package that includes flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.