Lab Billing Specialist

Overview:

Reviews lab encounters for appropriate demographic, insurance, and testing information. Screens encounters for valid ICD-9 diagnosis codes, makes appropriate requests from client for any encounters that need reviewed for valid ICD-9 following compliance guidelines. Applies appropriate modifiers to lab encounters and enters charges and CPT codes for lab sendout testing.  Embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values.

Education:

• Associate’s degree in science, business or related discipline required. Two years experience in billing/coding, working with laboratory related applications, or related experience may be considered in lieu of degree.

Experience:

• Minimum three years experience in a hospital setting utilizing hospital and/or laboratory information systems with at least one year billing and coding experience required.

Other Knowledge/Skills/Abilities:

• Knowledge of ICD-9, CPT, HCPC, and modifier codes required.
• CPT coding and lab modifier training within 1 year.
• Ability to work in the following programs: Microsoft Excel and Word

1. Applies modifiers to all Pathology and Cytology lab testing by utilizing a complete review of the daily charge log from the lab LIS system.

1. Applies modifiers to all Clinical Lab Testing utilizing specific logs built for like and unlike CPT code review.

1. Applies all charges for lab sendout testing. Includes monitoring all reference lab fee schedules and invoices to ensure pricing is up to date. Updating pricing in hospital billing system for all sendouts without chargemaster code set up. Splits charges appropriately and applies correct test description and modifiers in hospital billing system.

1. Trains and educates Lab Billing Specialists I.

1. Embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values:

1. Correctly interprets and inputs all necessary demographic, insurance, and testing information into the laboratory and registration computer systems.

1. Screens lab outreach and outpatient orders for appropriate ICD-9 diagnosis codes utilizing 3M.

1. Screens lab outreach and outpatient orders for appropriate CPT codes for Medical Necessity utilizing NDAS software.

1. Follows-up with physician’s office on any invalid ICD-9 or inappropriate ICD-9 diagnosis codes to ensure prompt payment of encounter.

1. Responds to client inquiries concerning billing discrepancies, appropriate ICD-9 Diagnosis coding and accurate transmittal of CPT-4 Codes to the client sites.

1. Evaluates all ABN’s received and ensures ABN’s are valid, flagged in the registration system, and scanned into the medical record.

1. Monitors daily worklists of pending diagnosis reviews from coding department.

1. Promotes an attitude of teamwork and effective communication and rapport with managers and staff of the Laboratory and Memorial Health System.

1. Works closely with laboratory information systems analysts to identify problems related to the Outreach computer programs.

1. Responds to basic requests from Patient Financial Services for review of CPT codes, ICD- 9 codes and patient questions regarding Lab Billing.

1. Understands all insurance carrier codes and policy numbers for all MMC payers. Knowledge of charity care programs offered by MMC.

1. Ability to credit, reverse charges, and make all other required updates to ensure a lab encounter is compliant.

1. Reviews specific daily reports to reconcile any issues holding up an account for billing including date of service issues.

1. Monitors specific logs for diagnosis review including CRN58, CRN57 to ensure coding has a valid diagnosis to code order.

1. Receives all emails from Patient Financial Services requesting an encounter review. This could include CPT code review, modifier review, payment denial, or requesting additional documentation for encounter.

1. Provides support for Lab leadership.

1. Conforms to Memorial Medical Center strategic plan and philosophy regarding the Guest Relations Program.

1. Performs other related work as required or requested.

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job.  Incumbents may be requested to perform tasks other than those specifically presented in this description.