Role Description The Laboratory Billing & Coding Representative is responsible for accurate and timely billing of Laboratory services. Key responsibilities include:

• Understanding medical terminology, patient registration, insurance eligibility, payer rules, CPT/HCPCS bundling, CCI modifiers, and lab-related coding for problem resolution.
• Applying compliance and regulatory guidelines to resolve charge review edits, claim edits, billing-related issues, and assigned work queues.
• Functioning as a lab-billing resource for internal and external parties.
• Using Carle electronic medical record systems and Lab Information System to review clinical encounters and laboratory results.

Qualifications

• Education: High School Diploma or G.E.D
• 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.

Requirements

• 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.

Benefits

• The compensation range for this position is $22.4 per hour - $37.41 per hour.
• Carle Health offers a comprehensive benefits package for team members and providers.

Company Description

At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected, and empowered. 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.
• 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.