Clinical Billing Specialist - Pathology & Laboratory Medicine

The hours for this position are Monday - Friday 8am - 5pm. The hybrid work schedule is 3 days onsite and 2 days remote during the training period. Once proficiency has been reached, the position will be days 4 days remote and 1 day onsite with an expectation to come onsite more, as needed.

The ideal candidate will have a bachelors degree with hands-on experience with Epic, demonstrating proficiency in managing physician templates and optimizing scheduling workflows. They will possess a strong understanding of the revenue cycle, including its impact on operational and financial outcomes, and have specific expertise in pathology coding or billing. This individual should be detail-oriented and skilled at navigating complex billing processes to ensure accuracy and efficiency.

SUMMARY

Responsible for identifying revenue cycle opportunities, analyzing data, and collaborating with others to optimize revenue.

JOB SPECIFIC COMPETENCIES

Planning and Coordination

Responsible for facilitating data, analytics, and various data driven initiatives pertinent to the revenue cycle within the Division of Pathology and Laboratory Medicine. Being a bridge between the provider, coding, reporting, clinical revenue & reimbursement, patient business services, contracting, Epic teams, and other revenue cycle functions. Works closely with pathologists and laboratory operations teams to identify and eliminate barriers to compliantly optimize reimbursement. Assists with provider onboarding and revenue cycle inquiries. Utilizes revenue cycle knowledge and experience to provide tools, technical, and analytical guidance to the division and departments.

Quality and Service Functions  

Works with providers and operations to ensure the quality and integrity of revenue cycle recommendations and data is compliant, accurate, consistent, relevant, and timely. Performs diligence, testing, and quality assurance to ensure solutions delivered are of the highest quality. Effectively communicates and partners with institutional offices to ensure delivery of compliant and optimal revenue cycle outcomes. Maintain current knowledge of applicable regulatory and compliance rules and regulations. Identify measures and tools to assist with optimal charge capture and prevention of leakage.

Financial and Analytics  

Extracts data, develops and presents logical and comprehensive analyses and/or summaries on key metrices, trends, opportunities, and prioritizes initiatives for improvement to revenue cycle areas, such as compliance, collections, denials, pricing, or other adjustments. Participates in budgeting and financial reporting processes, and periodic variance explanations. Establish and maintain monthly audit of PLM charging and coding practice.

Other duties as assigned