The Laboratory Reimbursement Specialist maximizes billing and reimbursement compliance in the laboratory for inpatients, outpatients, and clients. This position acts as a liaison between the laboratory, patient financial services, and reimbursement team members.
Essential Job Duties:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
- Investigates up-front and post-submission denials and edits through oral and written communication with insurance carriers and ordering providers.
- Manages assigned billing and charging work queues (WQs) by performed edits (CCI, MUE, etc.) and clearing errors in accordance with Federal guidelines regarding appropriate laboratory billing.
- Documents in EPIC system in accordance with PFS policies and procedures.
- Identifies negative trends and works to resolve with key personnel.
- Serves as the department's subject matter expert by sharing information and remaining current in reimbursement rules and trends. Represents laboratory in designated meetings.
- Foster the financial stewardship of the health system and Conexus Laboratories by maximizing reimbursement and reducing denials.
- Reviews client bills for accuracy and monitors clients for timely payment. Follows up on delinquent accounts.
- Provides data to Outreach department regarding relevant statistics and trends.
- Espouses the principals of Lean Thinking and creates a work environment that positively promotes process improvement. Explores opportunities to add value to job (innovative ideas) to benefit the organization and taking ownership of the outcome. Proactively finds other work-related tasks during low census.
- Actively participate in the laboratory quality plan/program (ex. investigative reports, notification of delays, etc.).
- Associates' Degree from an accredited college or university.
- Experience with laboratory billing including CPT and ICD-10 coding
- Preferred Education: Bachelor's Degree from an accredited college or university with a laboratory science major.
- Preferred Experience: Three years of experience performing similar duties (including clinical and anatomical pathology billing).
Working Conditions, Equipment, Physical Demands:
Sedentary work. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.
Physical Demands -
The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.