DESCRIPTION:

Responsible for the daily operations associated with charge posting and reconciliation processes to standardize and optimize laboratory billing workflows.

Provides charge entry, insurance expertise, registration, and customer service to assist the laboratory department and patient and/or client through the revenue cycle for hospital and outreach accounts.

• Responsible for meeting charge posting deadlines and timely review/resolution of accounts holding for review/additional information/correction.
• Understands and utilizes computer billing system and maintains knowledge of industry regulations as related to hospital-based billing and outreach laboratory billing
• Works closely with external outreach billing vendor to optimize workflows and revenue capture.
• Acts as a liaison between the external outreach billing vendor (XIFIN) and Trinity Health treasury, finance and revenue integrity resources to facilitate seamless workflows associated with claims processing, payment posting, refunds and financial reporting.
• Develops and monitors daily reports for appropriate charging, coding/modifiers, transferring charges, correcting charges, reconciling charges, following up on delinquent reports, and problem solving with staff.
• Ensures work queues are managed in a timely manner. Ensures staff are trained and have functional knowledge of charge entry, CPT, and ICD-10 changes, coding practices and insurance terminology.
• Enters daily department charges, credit or add charges.
• Responsible for ensuring applicable rules and regulations for Medicare and other payers are being satisfied.
• Works with ordering personnel, including physician’s office staff, to resolve any discrepancies and provide education regarding medical necessity criteria and diagnosis codes to optimize claims payment on first submission.
• Responsible for updating patient registrations as needed by utilizing hospital and laboratory policies and procedures.
• Assures all areas of department maintain compliance to applicable billing and coding rules and regulations.
• Keeps abreast of insurance carrier rules and changes by participating in carrier specific education opportunities and email notifications.
• Develops procedures and protocols for laboratory billing.
• Acts as resource for billing system functionality, and identifies billing questions/concerns, pursuing and communicating resolution, as appropriate.
• Serves as a patient advocate in promoting clarity and understanding to efficiently and courteously answer client phone calls regarding billing, pricing and CPT codes.
• Reviews reimbursement and charges and provides recommendations to optimize revenues.
• Participates in meetings and on committees as required.
• Participates in the interview and hiring process for staff vacancies in the areas of responsibility.
• Schedules staff to ensure appropriate coverage. Monitors and adjusts staffing appropriate to the workflow.
• Develops and maintains orientation materials and coordinates completion of staff orientation.
• Completes annual performance evaluations and competency assessments.
• Performs disciplinary action when indicated.
• Ensures standard operating policies and procedures are current and adhere to the Laboratory’s document control system.
• Participates in lab leadership meetings to provide status updates regarding Billing activities and workflow optimizations.
• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

QUALIFICATIONS:

• Bachelor’s Degree required.
• Two years experience with healthcare billing and coding required.
• Basic knowledge of third party payor, insurance, and regulatory requirements required.
• Laboratory billing experience preferred.
• One year supervisory experience preferred.

Please refer the Job description for details