Laboratory Reimbursement Specialist

Position Objective:

Maximizes billing and reimbursement compliance in the laboratory for inpatients, outpatients, and clients. Acts as a liaison between the laboratory, billing services, and reimbursement team members. Functions with minimal supervision.

Essential Job Duties:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Investigate up-front and post-submission denials and edits through oral and written communication with insurance carriers, billing services, and ordering providers.
2. Manage assigned billing and charging work queues (WQs) by performing edits (CCI, MUE, etc.) and clearing errors in accordance with Federal guidelines regarding appropriate laboratory billing.
3. Document in the EPIC system in accordance with health system policies and procedures.
4. Identify negative trends and work to resolve with key personnel.
5. Serve as the department’s subject matter expert by sharing information and remaining current in reimbursement rules and trends. Represent the laboratory in designated meetings.
6. Foster financial stewardship of the health system and Conexus Laboratories by maximizing reimbursement and reducing denials.
7. Review client bills for accuracy and monitor clients for timely payment. Follow up on delinquent accounts.
8. Provide data to laboratory outreach leadership regarding relevant statistics and trends.
9. Create a work environment that positively promotes process improvement. Explore opportunities to add value to the job (innovative ideas) to benefit the organization and take ownership of outcomes. Proactively find other work-related tasks during downtime.
10. Actively participate in the laboratory quality plan/program.

Educational/Experience Requirements:

Required Minimum Education:

• Associates Degree from an accredited college or university with coursework sufficient to meet the requirements of the American Society of Clinical Pathology (ASCP) for certification as a Medical Laboratory Technician, Medical Technologist, Medical Laboratory Scientist, Specialist, or HEW/AMT.

Required Minimum Experience:

• Two years of experience performing similar duties (including clinical and anatomical pathology billing), preferred

Required License/Certifications:

• MLT(ASCP), MLS(ASCP), MT(ASCP), categorical or specialist (ASCP), MT(HEW), or MT(AMT), preferred

Knowledge, Skills, Abilities:

• Ability to work cooperatively with all types of personalities both inside and outside the organization

Working Conditions, Equipment, Physical Demands:

Physical Demands – Medium Duty

The physical demands and work environment described are representative of those encountered while performing the essential functions of this position. Reasonable accommodations may be made under the Americans with Disabilities Act.

There is a reasonable expectation that employees in this position will be exposed to blood-borne pathogens.

The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.