Billing & Coding Spec - Lab

Billing & Coding Spec - Lab Phoenix Children's Hospital - 3.7 Phoenix, AZ Job Details Full-time 17 hours ago Benefits Health insurance Qualifications Business financial process improvement Medical coding compliance oversight Regulatory compliance in claims processing Compliance audits & assessments Process improvement Mid-level Invoice processing CMS regulatory compliance Quality assurance audits Policy & process development GAAP Laboratory compliance Centers for Medicare and Medicaid Services (CMS) Laboratory quality control Medical billing Accounting standards Quality audits Hospital regulatory compliance Escalation handling Internal financial audits Financial compliance Account reconciliation Full Job Description This position is responsible for prompt and accurate billing for all hospital laboratory and pathology professional billing services, including but not limited to, reviewing system error reports and resolution of billing exceptions, auditing of referral lab invoices, developing and maintaining reference testing 3rd party billing workflows, providing support for all clinical and anatomic pathology billing needs, and ensuring laboratory billing is current and appropriate for all testing. Assists in reviewing recommended CPT codes for in-house and reference lab testing and provides guidance to Laboratory and Revenue Integrity teams. This role is also responsible for monitoring healthcare rule and regulation changes to maintain billing compliance. It will partner with hospital billing and finance teams in the development and execution of billing process improvements related to compliance and reimbursement of laboratory testing and assist in the development and maintenance of policies and procedures. Position Duties Review billing system error reports and resolve billing exceptions by providing accurate and timely documentation; proactively escalate billing issues or and insights on new billing trends to the Lab Business Operations, and Revenue Cycle teams Provide billing operational support, which includes error processing, charge entry and credit, and CPT code verification to Lab Business Operations, and Revenue Cycle teams Develop internal audits and quality controls, in accordance with departmental policies, procedures, generally accepted accounting practices and all applicable laws and regulations, to certify all laboratory billing (in-house, send out, and Pathology professional practice (PCMG)) is in compliance with National and Local Coverage Determinations (NCD and LCD) policies. Review and revise standard laboratory billing processes and procedures; develop new billing standard operation procedures as applicable Review and reconcile referral lab invoices to verify pricing, patient billing accuracy, and approvals for timely payments. Monitor changes to CMS and commercial payor rules and regulations to maintain billing compliance. Assist in creating and maintaining a routine audit process of the ChargeMaster for laboratory testing charges and costs in close collaboration with Revenue Integrity. Maintains professional and technical competency in all aspects of laboratory billing and coding with respect to governmental and commercial payor practices and requirements. Performs miscellaneous job related duties as requested. Phoenix Children's Mission, Vision, & Values Mission To advance hope, healing and the best healthcare for children and their families Vision Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

We realize this vision by:

Offering the most comprehensive care across ages, communities and specialties Investing in innovative research, including emerging treatments, tools and technologies Advancing education and training to shape the next generation of clinical leaders Advocating for the health and well-being of children and families Values We place children and families at the center of all we do We deliver exceptional care, every day and in every way We collaborate with colleagues, partners and communities to amplify our impact We set the standards of pediatric healthcare today, and innovate for the future We are accountable for making the highest quality care accessible and affordable