Overview

The Laboratory Billing & Coding Representative is responsible for accurate and timely billing of Laboratory services. Responsible for understanding medical terminology, patient registration, insurance eligibility, payer rules, CPT/HCPCS bundling, CCI modifiers, and lab-related coding for problem resolution. Responsible for understanding and applying compliance and regulatory guidelines to resolve charge review edits, claim edits, billing-related issues, and assigned work queues. Functions as a lab-billing resource for internal and external parties. This position uses Carle electronic medical record systems and Lab Information System to review clinical encounters and laboratory results.

Responsibilities

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

Qualifications

Certifications: ,

Education: High School Diploma or G.E.D

Work Experience: Knowledge of patient registration, billing processes, medical terminology, and coding applicable to position. Ability to deal with a large volume of work, multitask, easily accept and implement change, and perform computer data entry. Basic/Intermediate Level experience in Microsoft Outlook, Word, Excel, and Teams. Ability to work with others collaboratively, both orally and in writing.

Company Overview

Find it here. Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health. Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois. We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.