Laboratory Charge Specialist - Lab-Admin

GENERAL SUMMARY:

The Charge Specialist is expected to use their AAPC certification and knowledge base to monitor and review all aspects of technical charges in the laboratory work queues to ensure that we maximize reimbursement based on the most appropriate procedural and diagnosis codes. They function independently and as part of a team that corrects billing errors or omissions that then allow for clean claims to be billed to third party commercial and federal insurance carriers.

The Charge Specialist reviews individual patient accounts in laboratory work queues in the Epic HB module. They are reviewing charges pre-billing that lack a covering diagnosis code for the laboratory testing performed and hold up claims due to lack of medical necessity per local and national coverage policies. In addition, they also review patient accounts on work queues that have been denied payment by the insurance carriers to resolve the reason for the denial in consultation with the ordering provider. The incumbent works closely with the
Daily duties consist of reviewing orders, collecting charge and diagnostic information, reviewing the
accuracy of the charge information, reviewing clinical records for appropriate documentation,
investigating questionable coding practices, communicating with providers and office staff, and
performing charge corrections and credits. They are also expected to respond to queries from clinicians and peers about diagnosis issues relating to patient accounts.
The Charge Specialist is responsible for training new employees in the billing functions, coordinating
workload and updating the Manager.

QUALIFICATIONS:
Education/Skills Required:

1. High School diploma or GED required. Medical coding certification by AAPC, or equivalent, is required for this position. Applicants who are currently studying for their certification will be considered based on their experience. In that circismtance, successful completion of coding certification rquired within 12 months of hire.

2. Four (4) years of relavent experience in a medical billing enrironment, including CPT and ICD coding. Minimum of two (2) years laboratory experience preferred.

3. Medical terminology, preocedural and diagnostic coding required. Must have knowledge of CPT and ICD codes and HCPCS soding. Experience with third party payers and regulatory requirements preferred.

4. Well versed in the use of Electronic Medical Records billing modules, and with Word and Excel. Must be a self-motivated, detail-oriented professional. Self-motivated to work independently with various levels of staff, administrative and clinicians. Must have excellent professional communication skills including writted, verbal and telephonic.

As applicable, the individual has training/competency in attending to the special needs and/or behaviors appropriate to the age of the patients for which care is being provided.