Clinical Billing Specialist, Lab Outreach

Pay Range: $19.34 – $28.16 per hour

Your starting hourly wage will be directly based upon years of relevant experience to the position. We will give you full credit for each year of past experience you have.

Basic Job Function and Responsibilities

Coordinate, implement, and monitor all billing practices and procedures for all aspects of the billing process  to insure full , timely, and accurate reimbursement in compliance with all state, local, and federal regulations.

Job Duties/Performance Expectations

• Acquire and maintain expertise for appropriate use and application of diagnosis codes, CPT codes, billing modifiers, CCI and mutually exclusive edits as it pertains to the appropriate specialty.
• Acquire and maintain knowledge and understanding of test request forms and electronic test request and reporting systems for billing verification and audit purposes.
• Acquire and maintain expertise on all billing system functions and revisions, interfaces, and data base maintenance.
• Research, develop, maintain, utilize, and interpret all billing reports, including but not limited to edit, and/or rejection reports from billing systems.
• Acquire and maintain knowledge of, and insure appropriate application of all third party payor regulatory requirements and guidelines including but not limited to medical necessity, use of patient waivers, etc.
• Research, monitor, and insure adherence to all applicable corporate and OIG compliance standards, HIPAA standards, CLIA standards, and/or all other applicable government or non government regulatory agency standards.
• Acquire and maintain knowledge and competence on accurate interpretation of explanation of benefits (EOB) and all billing correspondence from third party payors, clients and patients.
• Research, analyze, and correct returned mail as per standard operating protocol while maintaining complete, accurate, and descriptive supporting documentation.
• Research, analyze, and monitor all regulatory payment requirements, claim filing requirements, and upcoming revisions, changes, and/or updates with recommendations for action submitted to department director proactively.
• Research, develop, implement, and monitor departmental policies and procedures.
• Explanation and dissemination of all changes, updates, revisions through written and/or verbal methods to billing staff and/or other hospital departments upon approval by director.
• Interaction, verbal and written, with client facilities and/or third party payors for documentation and/or clarification of clinical information necessary for billing while maintaining complete, accurate, and descriptive supporting documentation.
• Review and correction of all pending claims rejected or flagged by billing system and clearinghouse.
• Preparation, analysis, validation/verification, and submission of all claims (paper and UB format) to all third party payors, electronically or via us mail.
• Research, correct, and resubmit insurance claims rejected by third party payors including use of the appeals process while maintaining complete, accurate, and descriptive supporting documentation.
• Posting, daily deposits, and reconciliation of all payments received into Laboratory Outreach including but not limited to patient, client, and third party by manual and electronic methods.
• Research, verify, and place accounts for collection proceedings as determined by standard operating procedures while maintaining complete, accurate, and descriptive supporting documentation.
• Provide direction and guidance to all billing staff and assist with problem resolution while maintaining complete, accurate, and descriptive supporting documentation.
• Analyze and adjust patient and/or client accounts while maintaining complete, accurate, and descriptive supporting documentation.
• Create and verify weekly and monthly billing statements for clients and patients in a manner consistent with insurance explanation of benefits (EOB) while maintaining complete, accurate, and descriptive supporting documentation.
• Maintain excellent, respectful, and comprehensive communication skills (written and verbal) for correspondence with insurance companies, third party payers, other hospital employees, clients, and patients.
• Research and compile data necessary to prepare any requested or required audit reports, cost reports, quality assurance activities, and/or reimbursement analysis.
• Prepare and coordinate process for scanning and storage of all records and documents at an off site facility.
• Coordinate, test, and validate billing system functionality during hardware and software updates and enhancements.
• Interact with other hospital departments relevant to consistent billing operations and fiscal concerns.
• Develop and implement training and continuing educational programs for billing staff members in coordination with department director with on going monitoring of performance of staff with reports provided to director.
• Respectful and confidential discussion, arrangement, and resolution of financial concerns/assistance with patients and clients pre and post service and assist patients in the financial assistance process.
• Perform all daily, weekly, monthly and annual functions of the billing systems.
• Provide back up phone assistance and clerical support to other lab outreach areas.
• Performs other related duties as assigned.

Education

• Associate degree in accounting or business-related field, or equivalent experience – Required

Experience

• Knowledge of Third Party Payor reimbursement requirements – Required
• Minimum one year, knowledge of accounts receivable accounting and experience in accounts – Required
• Personal computer experience with working knowledge of Excel and
• Word – Required
• Minimum 2 years, bookkeeping or accounting experience – Required
• Healthcare experience – Preferred