Provides charge entry, insurance expertise, registration, and customer service to assist the laboratory department and patient and/or client through the revenue cycle for hospital and outreach accounts.   

• Maintains functional knowledge of charge entry, CPT, and ICD-10 changes, coding practices, and insurance terminology.  

• Enters daily department charges, credit or add charges.   

• Monitors reports  and work queues for appropriate charging, coding/modifiers, transferring charges, correcting charges, reconciling charges, following up on delinquent reports, and problem solving with staff. 

• Verifies that the diagnosis codes and corresponding laboratory tests meet the medical necessity criteria to assure claims are paid on the first submission.  Work with ordering personnel, including physician’s office staff, to resolve any discrepancies and provide education. 

• Responsible for updating patient registrations as needed by utilizing hospital and laboratory policies and procedures. 

• Keeps abreast of insurance carrier rules and changes by participating in carrier specific education opportunities and email notifications. 

• Meets charge posting deadlines and timely reviews/resolves accounts holding for review/additional information/correction.  

• Works proficiently in EPIC and XIFIN’s system to manage work queues supporting timely claims processing, client or patient billing. 

• Assists with the development and maintenance of departmental policies and procedures. 

• Understands and utilizes computer billing system and maintains knowledge of industry regulations as related to hospital-based billing and outreach laboratory billing.  

• Acts as resource for billing system functionality, and identifies billing questions/concerns, pursuing and communicating resolution, as appropriate. 

• Serves as a patient advocate in promoting clarity and understanding to efficiently and courteously answer client phone calls regarding billing, pricing and CPT codes.  

• Provides recommendations to optimize revenues.  

•  Serves as a resource person to laboratory staff and customers. 

•  Participates in meetings and on committees as required or assigned. 

• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior. 

General Requirements: