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Billing Operations Specialist

2 months ago

Young, Arizona, United States Sonora Quest Full time

Primary Location:
Tucson, Arizona

Department:
LTC Client Billing-Ref Lab

Shift:
Day

Job Category:
Revenue Cycle Management

POSITION OVERVIEW

This role is pivotal in overseeing the billing interactions with Laboratory Sciences/Sonora Quest Laboratories, as well as all internal and external stakeholders. The objective is to enhance, educate, and resolve any billing-related services, issues, and processes, thereby addressing concerns related to client retention, quality service, revenue targets, training, and alignment with the Company's mission.

All personnel are expected to adhere to the Company's policies and procedures, uphold safety standards, and contribute to the Company's overarching goals and mission.


KEY RESPONSIBILITIES

  • Identifies and educates key billing offenders (external clients) who contribute to a significant number of unbillable errors due to various factors, including incomplete billing information. Collaborates with management to develop strategies aimed at minimizing errors while ensuring compliance with all policies. Maintains a thorough understanding of regulations concerning fraudulent or non-compliant practices, whether internal or related to insurance and government guidelines.
  • Enhances profitability by reducing errors, engaging in specific projects quarterly, and achieving financial objectives. Stays informed about updates to Medicare guidelines, payer contractual requirements, denial reasons, modifier updates, and reimbursement changes. Documents all communications with clients, insurance entities, Account Managers/Executives, and internal departments in Salesforce and Xifin. Handles and responds to billing inquiries.
  • Standardizes, updates, and maintains all training materials and documentation. Provides necessary EP letters, Client requisitions, and ABN forms, while coordinating with Customer Systems and Marketing for client system requirements.
  • Facilitates communication and provides necessary support to Sales Account Managers/Executives regarding client issues, education, training, and billing requirements to ensure proper reimbursement. Investigates and addresses all inquiries from Sales Account Managers/Executives, PSC and IOP Supervisors, and Internal Management concerning client, patient, policy, reimbursement, or billing process queries.
  • Acts as a liaison between the Sales Department and both External and Internal Departments to communicate customer needs and requests. Proposes and evaluates innovative billing processes to meet customer demands while fulfilling business requirements and adhering to all billing standards. Monitors and analyzes ongoing client errors and communicates any non-compliant or unresponsive feedback from External Customers.
  • Establishes and nurtures positive, proactive relationships. Conducts Service & Guidance visits as time permits, engages with New Clients, and provides In-service Training for Clients, which includes tailored research, resource provision, and ensuring Quality Customer Service to maintain business relationships. Regularly provides feedback and follow-up to Clients regarding persistent errors, improvements, and updates on billing guidelines and policies.
KNOWLEDGE/SKILLS/ABILITIES
Ability to learn SQL billing systems, policies, and procedures.

Excellent verbal and written communication skills.

Strong proficiency in PC and system applications (billing and laboratory) with experience in Excel, Windows, and database platforms.

Good understanding of medical terminology and/or CPC coding or equivalent.

MINIMUM REQUIREMENTS
Associates Degree in Business, Medical Billing, or Medical Management with three (3) years of experience in Laboratory Billing or Medical Billing Management,

OR

High School Diploma/GED with five (5) years of experience in Laboratory Billing or Medical Billing Management.

Willingness to travel frequently.

Valid state Driver's License with a clean driving record.

PREFERRED QUALIFICATIONS
Additional education and relevant experience.

EOE/Female/Minority/Disability/Veterans
Our organization promotes a drug-free workplace.

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