Advance Beneficiary Notice (ABN), Ambulatory Care, Analysis Skills, Billing, Channel Strategies, Clinical Laboratory, Communication Skills, Corrective Action, Current Procedural Terminology (CPT), Demographics, Denials Management, Detail Oriented, Documentation, Electronic Medical Records, Healthcare Common Procedure Coding System (HCPCS), Healthcare Reimbursement, Hospital, ICD-10, Information Technology & Information Systems, Interpersonal Skills, LCD (Liquid Crystal Display), Laboratory, Laboratory Operations, Laboratory Testing, Leadership, Maintain Compliance, Medical Billing, Medical Coding, Medicare, Metrics, Patient Care, Patient Care Denials, Patient Registration, Performance Analysis, Performance Metrics, Phlebotomy, Problem Solving Skills, Process Improvement, Quality Assurance, Quality Management, Regulations, Regulatory Requirements, Reimbursement, Requirements Validation/Verification, Team Player, Test Requirements, Training/Teaching, Trend Analysis, User Interface/Experience (UI/UX)
Hospital Revenue Cycle Specialist - Lab
The Hospital Revenue Cycle Specialist - Lab serves as the primary connection between the Laboratory, Revenue Cycle, Patient Access, and Ordering Providers. This position is responsible for ensuring accurate front-end processes for laboratory patients-including registration, insurance verification, and medical necessity/ABN workflows-while also supporting downstream billing, coding, reimbursement, and denial management. The role requires a strong understanding of lab operations, CPT/HCPCS and ICD-10 coding, ABN regulations, payer policies, and the communication skills necessary to collaborate with physicians and clinical staff. This position has a dotted-line reporting relationship to the Patient Access Assistant Director and the Laboratory Director to support alignment with laboratory operations, regulatory requirements, and organizational goals across both departments.
Education: High school diploma or equivalent required; college degree in a business-related field preferred.
Experience Required: Minimum two years of experience in revenue cycle, patient access, laboratory operations, or medical billing/coding. Working knowledge of CPT/HCPCS codes, ICD-10 coding, and medical necessity requirements. Familiarity with Medicare ABN regulations and payer coverage policies related to laboratory services. Experience with insurance verification and patient registration workflows.
Experience Preferred: Experience in a hospital or ambulatory care laboratory environment. Prior experience with denials management and payer follow-up. Proficiency with EMR and revenue cycle information systems, including registration, billing, and reporting modules. Laboratory billing experience.
Licenses/Certificates: Certified Professional Coder (CPC) or Certified Revenue Cycle Representative (CRCR) preferred, not required.
Skills: Detail-oriented, accurate, and able to problem-solve complex revenue cycle issues. Strong analytical skills and ability to interpret coverage guidelines. Excellent interpersonal and communication skills, including provider-level communication. Ability to manage competing priorities and maintain professionalism in a fast-paced environment. Commitment to compliance, quality, and positive patient experience.
Essential Job Functions (including, but not limited to):
- Lab Revenue Cycle & Billing Support: Review lab orders for completeness, accuracy, and compliance with payer and Medicare requirements. Validate correct CPT/HCPCS coding and ICD-10 diagnosis alignment for laboratory tests. Work closely with coders and billing teams to address lab-specific edits, claim holds, and documentation needs. Prepare and present lab-related denial trends, root-cause issues, and corrective action recommendations. Serve as the primary point of contact for lab claim denials, including medical necessity, bundling, coverage, and documentation-related denials. Monitor payer policies impacting lab billing and communicate updates to lab, revenue cycle, and clinical teams.
- Physician & Provider Engagement: Collaborate directly with ordering providers and their staff to resolve diagnosis code and documentation issues that affect coverage or reimbursement. Provide education to physicians regarding medical necessity requirements, ABN rules, and documentation needed for successful claim submission. Serve as liaison between the lab and referring clinics to streamline workflows and reduce recurring denial patterns.
- Compliance & Quality Assurance: Ensure adherence to Medicare ABN rules, national and local coverage determinations (NCD/LCD), and payer-specific lab coverage policies. Maintain working knowledge of lab workflows, testing requirements, and specimen/order prerequisites. Participate in audits, quality improvement initiatives, and corrective action plans related to laboratory revenue cycle performance. Assist in training patient access and lab staff on process updates and billing requirements.
- Reporting & Performance Monitoring: Track daily, weekly, and monthly lab registration accuracy, ABN completion rates, medical necessity failures, and denial volumes. Identify trends, provide analysis, and partner with the Revenue Cycle leadership to implement process improvements. Support departmental KPI tracking and reporting for lab-related revenue cycle metrics.
- Front-End Patient Access Responsibilities: Perform accurate patient registration for lab services, ensuring complete demographic, insurance, and financial information. Conduct insurance verification and eligibility checks for all scheduled and walk-in lab patients. Validate medical necessity and capture ABN requirements when applicable. Ensure collection and documentation of patient liability amounts, deductibles, coinsurance, and prior balances when appropriate. Support daily lab patient workflow, coordinating with phlebotomy and clinical staff to minimize waiting times and improve patient experience.