Laboratory Revenue Integrity Specialist

Overview

The Laboratory Revenue Integrity Specialist rles Health System (SCHS) provides excellent customer service and facilitates team engagement in every interaction. Supports SCHS and Community Connect Partners for laboratory revenue integrity by identifying and resolving billing and charge capture issues. This role ensures accurate CPT/HCPCS coding, laboratory charge linkage and online test catalog, supports CLIA certificate management, and assists with laboratory claim denials and provider education.

The position works closely with Revenue Cycle and Laboratory teams to support compliant and accurate billing practices and does not directly supervise other caregivers.

• Investigate, identify, and resolve laboratory charge capture, procedure coding, and denial issues, in a timely manner.
• Provide 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 charge master.
• 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 charge master updates including descriptions, revenue codes, cost centers, pricing, and fee schedules.
• Collaborate with charge master team, SCHS technical managers, supervisors, and Community Connect Partners to ensure charge master 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 work queues, 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, charge master 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.

Required: High school diploma or GED.

Preferred: Associate or Bachelor’s degree in Health information or Healthcare Administration, or related courses.

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

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

Required: Minimum of three years’ experience working in a medical or hospital laboratory setting.

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