Billing \u0026 Coding Spec - Lab

Position Details

Department: PCH-MAIN | Lab Administration

Location: Phoenix

Shift: Mon-Fri, Days, 8am-5pm

Category: Hlth Info Mgmt/Med Records

Posting #: 1018716

Employee Type: Full-Time

Position Summary

This position is responsible for prompt and accurate billing for all hospital laboratory and pathology professional billing services, including but not limited to, reviewing system error reports and resolution of billing exceptions, auditing of referral lab invoices, developing and maintaining reference testing 3rd party billing workflows, providing support for all clinical and anatomic pathology billing needs, and ensuring laboratory billing is current and appropriate for all testing. Assists in reviewing recommended CPT codes for in-house and reference lab testing and provides guidance to Laboratory and Revenue Integrity teams. This role is also responsible for monitoring healthcare rule and regulation changes to maintain billing compliance. It will partner with hospital billing and finance teams in the development and execution of billing process improvements related to compliance and reimbursement of laboratory testing and assist in the development and maintenance of policies and procedures.

Position Duties

• Review billing system error reports and resolve billing exceptions by providing accurate and timely documentation; proactively escalate billing issues or and insights on new billing trends to the Lab Business Operations, and Revenue Cycle teams

• Provide billing operational support, which includes error processing, charge entry and credit, and CPT code verification to Lab Business Operations, and Revenue Cycle teams

• Develop internal audits and quality controls, in accordance with departmental policies, procedures, generally accepted accounting practices and all applicable laws and regulations, to certify all laboratory billing (in-house, send out, and Pathology professional practice (PCMG)) is in compliance with National and Local Coverage Determinations (NCD and LCD) policies.

• Review and revise standard laboratory billing processes and procedures; develop new billing standard operation procedures as applicable

• Review and reconcile referral lab invoices to verify pricing, patient billing accuracy, and approvals for timely payments.

• Monitor changes to CMS and commercial payor rules and regulations to maintain billing compliance.

• Assist in creating and maintaining a routine audit process of the ChargeMaster for laboratory testing charges and costs in close collaboration with Revenue Integrity.

• Maintains professional and technical competency in all aspects of laboratory billing and coding with respect to governmental and commercial payor practices and requirements.

• Performs miscellaneous job related duties as requested.