[Hiring] Medical Billing Specialist and Certified Coder @Carle Health

Role Description

The Laboratory Billing & Coding Representative is responsible for accurate and timely billing of Laboratory services. This includes:

• Understanding medical terminology, patient registration, insurance eligibility, payer rules, CPT/HCPCS bundling, CCI modifiers, and lab-related coding for problem resolution.
• Applying compliance and regulatory guidelines to resolve charge review edits, claim edits, billing-related issues, and assigned work queues.
• Functioning as a lab-billing resource for internal and external parties.
• Using Carle electronic medical record systems and Lab Information System to review clinical encounters and laboratory results.

Qualifications

• Certifications:
  • Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC)
  • Certified Outpatient Coder (COC) - American Academy of Professional Coders (AAPC)
  • Certified Coding Specialist - Physician-Based (CCS-P) - American Health Information Management Association (AHIMA)
  • Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA)
• Work Experience: Revenue cycle; Coding

Requirements

• Resolving Lab-related CPT, HCPCS, and applicable ICD-10 inquiries for internal and external parties.
• Editing laboratory test charges to ensure CPT/HCPCS codes are appropriate for tests being billed and appropriate modifiers are applied.
• Ensuring all charges are corrected when additional tests are ordered, or tests are cancelled at a later date.
• Researching and resolving assigned billing reports and work queues on a daily basis for registration errors, charge review, claim edits, etc.
• Understanding and applying compliance, regulatory, and CPT/HCPCS bundling rules for Laboratory billing.
• Facilitating maximization of revenue by ensuring correct coding initiatives and payer-specific guidelines are applied appropriately.
• Collaborating with Revenue Cycle, Coding, and other departments to resolve patient or payer-related charge and account inquiries, coding, denials, lab orders, trends, etc.
• Reconciling Referred (send-out) Testing invoices, calculating charges, keying billable services into systems, and reporting discrepancies to appropriate internal and external parties.
• Communicating issues and trends to management to maintain departmental compliance and improve processes.
• Attending and providing input at meetings and trainings.
• Assisting with Reference Laboratory billing processes.
• Assisting with financial and statistical reports.
• Ensuring quick responses to clients and patients regarding billing concerns.
• Ensuring daily work assignments are complete by promoting teamwork and good communication.
• Assisting with audits, special projects, and annual policy and procedure review process as requested.

Benefits

• The compensation range for this position is $23.58 per hour - $39.38 per hour.
• Actual compensation offered will depend on various factors including experience, qualifications, location, training, licenses, shifts worked, and compensation model.
• Carle Health offers a comprehensive benefits package for team members and providers.