Provider‑Based Billing (PBB) Compliance & Optimization Specialist

Regulatory & Compliance Oversight:

• Independently determine PBB eligibility for new and existing clinic locations.
• Lead completion of CMS PBB Attestation for all hospital-owned clinics and facilities.
• Conduct scheduled annual compliance reviews to ensure continued compliance with CMS regulations.

Financial & Revenue Cycle Analysis:

• Conduct financial modeling for PBB conversions, estimating facility fee revenue and payer-specific reimbursement.
• Analyze expected vs. actual revenue performance for all PBB locations and identify root causes of variances.
• Develop recurring reports and dashboards to track financial performance trends across the PBB portfolio.

EHR & Billing Systems Accuracy:

• Responsible for the accuracy of Epic configuration requirements for PBB designation, acting as the central liaison between Operations, Finance, Revenue Cycle, and IT.
• Conduct routine audits to ensure correct utilization of PBB logic across all visits, providers, and departments.
• Monitor Epic system changes that may affect PBB rule setup and engage stakeholders to evaluate the impact.