Lab Billing and Compliance Coordinator

Summary

• Position Summary
  • The Laboratory Billing and Compliance Coordinator is responsible for ensuring the validity of the laboratory financial business.  Manages alongside their peers, the receivable, registration, collections, contracting, denials, billing training, insurance listings, and the process for design, development, and implementation of education and billing compliance programs, and developing necessary tools for collection of data. Collates Performance Improvement (PI) data for reporting and sets annual objectives and key indicators. Reviews Laboratory Chargemaster, CPT coding and performs charge accuracy and documentation audits for all departments in laboratory. Keeps abreast of all billing regulatory guidelines.
• Education
  • Bachelor's Degree - Required
• Experience
  • 3-5 Years - Preferred
  • 4 Years applicable experience - Preferred
• License & Certification
  • National Certification - Preferred
  • Currently registered or registry eligible by the Board of Registry of the American Society of Clinical Pathologists or equivalent, if applicable.
• Core Job Functions
  • Organizes daily workload to achieve acceptable quality standards, recognizing weak areas and implementing appropriate additions to training. Identifies and implements a system to monitor effectiveness of training. Adapts readily to changes in workload and stressful situations, demonstrating confident and supportive behavior. Shows initiative to know where the focus of work is needed.
  • Understands the standards for Laboratory billing and ensures compliance. Works with administrative leaders to maintain compliance and best practices. Notifies Manager of on-going problems, and provides suggestions and solutions to problems.
  • Promotes a quality driven customer service-oriented reception, collection, and registration process.  Facilitates registration processes that lending to an ethical and fair billing opportunity within full compliance with Medicare, Medicare, Tricare, and/or any other third-party payer contract. Develops a process for Laboratory collections at time of service when appropriate.
  • Manages denial tracking and KPIs to improve denials and claim rejections.
  • Quality Metrics are tracked and maintained. Reviews and monitors to assess and identify on-going problems so that effective resolutions can occur. Facilitates the development of a billing compliance learning culture within the department to support change and continuous improvement alongside outreach team leads. Educational and competency program design includes overall service/program/activity goal, specific learning objectives, content and methods of evaluation. Works alongside Outreach team leads and coordinators to assure improvement. 
  • Maintains appropriate records in accordance with guidelines of regulatory agencies. Collaborates with departmental team leaders on billing compliance, CDM edits, CPT coding and billing audits.
  • Works with hospital and laboratory leadership to grow the laboratory business and ensure stable profit margins.