Laboratory Business Operations Specialist

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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 works in the Business Operations team, serving as a key technical resource while providing strategic guidance and expertise to all laboratory departments. This role is responsible for optimizing 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. Recommends 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 rules 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 development and maintenance of policies and procedures.

Position Duties

  • Review billing system error reports and resolve billing exceptions. Analyze error patterns, identify root causes, and develop systematic solutions; proactively escalate billing issues and insights on new billing trends to the Lab Business Operations, and Revenue Integrity and Compliance 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. Communicate with reference labs to troubleshoot issues.
  • Develop internal audits and quality controls, in accordance with departmental policies, procedures, generally accepted accounting practices and all applicable laws and regulations.
  • Lead strategic review and standardization of laboratory billing processes and procedures; develop new and maintain billing standard operation procedures as applicable
  • Review and reconcile referral lab invoices to verify pricing, patient billing accuracy, and approvals for timely payments.
  • Serve as lead on CMS and commercial payer rules and regulations. Proactively monitor, interpret, and communicate regulatory changes
  • Assist in creating and maintaining a routine audit process of the ChargeMaster, including changes, additions and deletions, 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. Participates in educational programs and learning opportunities.
  • 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. Bachelor’s Degree in a relevant field or Associate’s Degree coupled with two years of billing compliance experience.
Required

Experience

 Do you meet this requirement or have the ability to obtain it
within the timeframe listed in the requirement?
1. Advanced experience in laboratory coding, billing, and invoicing.
Preferred
2. Laboratory technical/technician experience.
Preferred
3. Revenue cycle payment collections skills and experience.
Preferred
4. Allscripts, SunQuest laboratory information system, and Image Express experience.
Preferred
5. Experience/knowledge with clinical laboratory and reference lab testing.
Preferred

Special Skills

 Do you meet this requirement or have the ability to obtain it
within the timeframe listed in the requirement?
1. The ability to work independently, handle multiple tasks, and exhibit problem-solving skills.
Required
2. High level of attention to detail, well-organized, and adept at effectively communicating with all levels of customers.
Required
3. Proven experience in Microsoft Office products including, at minimum, moderate competency with Excel skills.
Required
4. Comprehensive knowledge of CPT coding, HCPCS coding, modifiers, and government and commercial payor guidelines. Knowledge of professional fee billing, reimbursement, medical terminology, and HIPAA privacy laws.
Required

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