Apply on Employer Site

St. Charles Health System · 1 day ago

Laboratory Revenue Integrity Specialist

Bend, OR

Full-time

Onsite

Mid Level

3+ years exp

St. Charles Health System is seeking a Laboratory Revenue Integrity Specialist who provides excellent customer service and supports laboratory revenue integrity. This role involves identifying and resolving billing and charge capture issues, ensuring accurate coding, and collaborating with various teams to maintain compliant billing practices.

Health CareMedicalNon Profit

Responsibilities

Investigate, identify, and resolve laboratory charge capture, procedure coding, and denial issues, in a timely manner

Provides Laboratory Leadership/management reports as requested

Ensure accurate application of CPT/HCPCS codes and modifiers in accordance with regulatory and payer guidelines

Support resolution of medical necessity issues and laboratory denials

Assist with work queues to review and corrections of laboratory charges flagged for third-party edits, and Revenue Guardian checks

Collaborate with Revenue Integrity to improve issues with claim edits and minimize future errors

Maintain test code linkage between the Laboratory Information System (LIS) and the laboratory chargemaster

Update and manage CPT/HCPCS code assignments, charge codes, pricing of lab services, and charge information in the online test catalog

Maintain lab CMS pricing templates for price transparency requirements

Coordinate chargemaster updates including descriptions, revenue codes, cost centers, pricing, and fee schedules

Collaborate with chargemaster team, SCHS technical managers, supervisors, and Community Connect Partners to ensure chargemaster accuracy

Support the process and management of CLIA certification requirements across SCHS/SCMG laboratory testing sites, for CLIA certificate renewals, new applications, and updates per Joint Commission and state regulations

Support and assist in training laboratory staff on processes related to workqueues, and other laboratory specific workflows impacting timely claims and charge capture

Provide guidance on workflows and error resolution related to lab charge capture

Partner with providers and departments to support education related to laboratory charge capture, and compliance

Maintain detailed documentation for laboratory test change requests

Maintain professional knowledge by attending educational workshops, reviewing professional publications, participating in educational opportunities

Work closely with the Patient Financial Services on medical necessity issues, claim denials, chargemaster issues, and charge auditor issues

Deliver customer service and/or patient care in a manner that promotes goodwill, is timely, efficient, and accurate

Supports the vision, mission, and values of the organization in all respects

Supports Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change

Provides and maintains a safe environment for caregivers, patients, and guests

Conducts all activities with the highest standards of professionalism and confidentiality. Complies with all applicable laws, regulations, policies, and procedures, supporting the organization’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings

May perform additional duties of similar complexity within the organization, as required or assigned

Qualification

CPT/HCPCS codingLaboratory charge captureCoding CertificationMedical necessity resolutionLaboratory billing experienceCharge master managementCustomer serviceProfessional developmentCollaboration

Required

High school diploma or GED

Coding Certification of one or more of the following RHIT, RHIA, CPC, CCS, within one year of hire. Maintains required educational credits (CE)

Minimum of three years' experience working in a medical or hospital laboratory setting

Preferred

Associate or Bachelor's degree in Health information or Healthcare Administration, or related courses

Current certification of (RHIT, CPC, CCS), maintains required education credits (CE)

Three or more years in Laboratory billing/audits, billing edits, and resolutions in health system setting including CPT/HCPC codes, medical terminology, or medical coding and insurance billing for medical services