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Laboratory Billing Operations Specialist
2 months ago
USA Health is at the forefront of transforming healthcare along the Gulf Coast, addressing the distinct needs of our community.
We are redefining the impact of medical care, education, and research on the health of individuals residing in Mobile and its neighboring areas.
Our dedicated team, consisting of physicians, advanced care providers, nurses, therapists, and researchers, delivers the region's most sophisticated medical services across various facilities, campuses, clinics, and educational settings.
We ensure that patients have convenient access to groundbreaking treatments and advancements that enhance the health and overall wellbeing of our community.
Responsibilities
The Laboratory Billing Operations Specialist is responsible for reviewing charges and coding pertinent to laboratory billing systems to facilitate claim submissions. This role involves conducting lab system assessments related to revenue capture and auditing billing interactions with third-party billing entities for reference lab services and procedures.
This position acts as a vital communication link among laboratory personnel, physicians, third-party billing companies, and USA Health team members, addressing issues, recommendations, solutions, and inquiries related to patient charges, auditing, and laboratory claims billing.
The specialist collaborates closely with management, staff, IT, and hospital departments to ensure precise provider maintenance and diagnosis coding for laboratory claims, while adhering to quality standards within the department.
Key duties include:
- Educating staff on claims billing issues and revenue management.
- Notifying IT and management of necessary corrections and securing those adjustments.
- Reviewing and auditing patient billing from the previous day's entries and making adjustments as needed.
- Participating in interdepartmental meetings to resolve write-off issues.
- Maintaining knowledge of relevant billing programs for managerial recommendations.
- Revising the unit's charge master for accurate coding, pricing, and structure.
- Utilizing CPT, ICD, and HCPCS coding guidelines to validate and enter correct codes for third-party billing interfaces.
- Conducting daily charge reconciliations between laboratory information systems and other platforms to ensure proper billing.
- Monitoring web resources related to emergency services, reimbursement, and revenue management.
- Assisting providers with billing inquiries and providing constructive feedback.
- Collaborating with Charge Services to address any charging discrepancies.
- Working with third-party billing companies to review and resolve claim denials.
- Providing financial reports and analyses to the Lab Director to support process enhancements, increase reimbursement, and boost laboratory profitability.
- Engaging in assigned committees and participating in Performance Improvement activities through quality measurement or ICARE processes.
- Exhibiting regular and prompt attendance and the ability to work defined schedules, including overtime as required.
A high school diploma or equivalent is required, along with four years of experience in medical billing, medical coding, or directly related Electronic Health Record (EHR) experience. Proficiency in CPT, ICD, and HCPCS coding is highly preferred. Higher education or CPC certification may substitute for one year of required experience on a year-for-year basis.
Equal Employment Opportunity/Affirmative Action Employer
USA Health is an EO/AA employer and does not discriminate based on race, color, national origin, sex, pregnancy, sexual orientation, gender identity, gender expression, religion, age, genetic information, disability, protected veteran status, or any other applicable legally protected basis.
