Regional Lab Billing Specialist

Employment Type: Full time Shift: Day Shift Description: Provides charge entry, insurance expertise, registration, and customer service to assist the laboratory department and patient and/or client through the revenue cycle for hospital and outreach accounts. Maintains functional knowledge of charge entry, CPT, and ICD-10 changes, coding practices, and insurance terminology. Enters daily department charges, credit or add charges. Monitors reports and work queues for appropriate charging, coding/modifiers, transferring charges, correcting charges, reconciling charges, following up on delinquent reports, and problem solving with staff. Verifies that the diagnosis codes and corresponding laboratory tests meet the medical necessity criteria to assure claims are paid on the first submission. Work with ordering personnel, including physician’s office staff, to resolve any discrepancies and provide education. Responsible for updating patient registrations as needed by utilizing hospital and laboratory policies and procedures. Keeps abreast of insurance carrier rules and changes by participating in carrier specific education opportunities and email notifications. Meets charge posting deadlines and timely reviews/resolves accounts holding for review/additional information/correction. Works proficiently in EPIC and XIFIN’s system to manage work queues supporting timely claims processing, client or patient billing. Assists with the development and maintenance of departmental policies and procedures. Understands and utilizes computer billing system and maintains knowledge of industry regulations as related to hospital-based billing and outreach laboratory billing. Acts as resource for billing system functionality, and identifies billing questions/concerns, pursuing and communicating resolution, as appropriate. Serves as a patient advocate in promoting clarity and understanding to efficiently and courteously answer client phone calls regarding billing, pricing and CPT codes. Provides recommendations to optimize revenues. Serves as a resource person to laboratory staff and customers. Participates in meetings and on committees as required or assigned. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior. General Requirements: High School or GED required. One year experience with healthcare billing and coding preferred. Experience in accounts receivable or banking also considered. Associates Degree or Bachelor’s degree preferred. Laboratory billing experience preferred. Basic knowledge of third party payor, insurance, and regulatory requirements preferred. Working knowledge of computer information systems that utilize several computer applications concurrently. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law. Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. Together, we’re 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services. Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs. For more information, visit http://www.trinity-health.org. You can also follow Trinity Health on LinkedIn.