Billing & Coding Spec - Lab

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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.

Phoenix Children's Mission, Vision, & Values

Mission

To advance hope, healing and the best healthcare for children and their families

Vision

Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

We realize this vision by:

  • Offering the most comprehensive care across ages, communities and specialties
  • Investing in innovative research, including emerging treatments, tools and technologies
  • Advancing education and training to shape the next generation of clinical leaders
  • Advocating for the health and well-being of children and families
Values
  • We place children and families at the center of all we do
  • We deliver exceptional care, every day and in every way
  • We collaborate with colleagues, partners and communities to amplify our impact
  • We set the standards of pediatric healthcare today, and innovate for the future
  • We are accountable for making the highest quality care accessible and affordable

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.

Education

 Do you meet this requirement or have the ability to obtain it
within the timeframe listed in the requirement?
1. Associates Degree
Required

Experience

 Do you meet this requirement or have the ability to obtain it
within the timeframe listed in the requirement?
1. Minimum (1) years of direct laboratory billing and coding
Required
2. Comprehensive knowledge of ICD-10 coding, CPT coding, HCPCS coding, modifiers, and government and commercial payor guidelines
Required
3. Knowledge of professional fee billing, reimbursement, medical terminology, and HIPAA privacy laws
Required
4. Proven experience in Microsoft Office products including, at minimum, moderate competency with Excel skills
Required
5. High level of attention to detail, well-organized and adept at effectively communicating with all levels of customers
Required
6. Data entry, word processing skills and an aptitude for numbers
Required
7. The ability to work independently, handle multiple tasks and exhibit problem-solving skills are essential
Required
8. Understands and adheres to the highest ethical standards, duties, and obligations
Required
9. Advanced experience in laboratory coding, billing, and invoicing
Preferred
10. Revenue cycle payment collections skills and experience
Preferred
11. Allscripts, SunQuest laboratory information system, and Image Express experience
Preferred
12. Experience with clinical laboratory and reference lab testing
Preferred
13. Minimum (3) years of direct laboratory billing and coding
Preferred

Additional Requirements

 Do you meet this requirement or have the ability to obtain it
within the timeframe listed in the requirement?
1. Professional Coding Certification (CPC)
Preferred

Physical Requirements & Occupational Exposure/Risk Potential

1. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) - Occasionally
2. Physical Requirement - Hearing - Constantly
3. Physical Requirement - Reaching - Occasionally
4. Physical Requirement - Sitting - Constantly
5. Physical Requirement - Standing - Occasionally
6. Physical Requirement - Talking - Constantly
7. Physical Requirement - Walking - Occasionally
8. Physical Requirement - Near Vision - Constantly
9. Physical Requirement - Use of keyboard, mouse and/or computer equipment - Constantly
10. Occupational Exposure/Risk Potential - Inside office environment - Applicable
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply