Laboratory Billing Specialist

Job Requirements

Company Description

The University of Maryland Medical System is a 14-hospital system with academic, community and specialty medical services reaching every part of Maryland and beyond. UMMS is a national and regional referral center for trauma, cancer care, Neurocare, cardiac care, women’s and children’s health and physical rehabilitation. UMMS is the fourth largest private employer in the Baltimore metropolitan area and one of the top 20 employers in the state of Maryland. No organization will give you the clinical variety, the support, or the opportunities for professional growth that you’ll enjoy as a member of our team.

Job Summary

This role organizes, supervises, directs and performs billing operations within the Laboratory. This position functions as the primary laboratory resource for billing and charge integrity activities and serves as the key liaison between Laboratory Operations and Revenue Cycle departments to ensure accurate and compliant reimbursement for laboratory services. Requires practical knowledge of registration, coding, patient financial services and federal, state and payor-specific billing requirements.

Primary Responsibilities

• Maintains extensive knowledge of Current Procedural Terminology, Healthcare Common Procedure Coding System, and revenue codes related to laboratory services to ensure accuracy and compliance with all state and federal guidelines.
• Responsible for reviewing and resolving charge capture, coding, and revenue integrity checks in laboratory work queues.
• Ensures the implementation of frequent changes to comply with changing American Medical Association (AMA), payor requirements, and Health Services Cost Review Commission methodology.
• Responsible for identifying and implementing charge capture opportunities and process improvements.
• Performs internal reviews and audits to validate billing accuracy and compliance.
• Responsible for coding all new and miscellaneous tests for appropriate reimbursement and compliance with federal and state regulations according to established ICD-10 diagnosis coding and CPT-4 procedure coding.
• Responsible for performing manual charge entry for billing miscellaneous laboratory tests.
• Works collaboratively with Revenue Cycle, Coding and Patient Financial Services teams to resolve billing discrepancies, monitor claim denials and coordinate corrective actions to reduce future denials.
• Answers coding questions for laboratory personnel and physician offices to improve documentation supporting accurate charge capture.
• Communicates billing and charge capture issues to hospital operational stakeholders timely, providing clear details.
• Responsible for reconciliation of and corrections for monthly client bills.
• Maintains records and reports related to reconciliation activities.
• Independently troubleshoots and resolves problems, documents corrective actions, and provides training to prevent the reoccurrence of issues.
• Makes decisions regarding charge adjustments and other charge resolution techniques.
• Responds to clinical and customer concerns and independently resolves customer issues in a confidential manner, employing integrity and discretion.
• Attends and participates in in-service training and various educational programs for professional growth and development related to laboratory billing and reimbursement.
• Perform all other related duties as assigned.

Education & Experience - Required

• Bachelor’s Degree in Medical Laboratory Science / other specialty in Laboratory Medicine, Healthcare, Finance, Accounting or equivalent related subject .
• One year of experience in healthcare billing, laboratory operations, laboratory billing or revenue cycle functions .

Education & Experience - Preferred

• Experience with laboratory charge capture and reimbursement processes.
• Experience working within Epic or other electronic health record system.
• Knowledge of laboratory workflows and testing services.
• Preferred certifications: Certified Revenue Cycle Representative (CRCR), Certified Professional Biller (CPB), Certified Professional Coder (CPC), Epic Certification or proficiency in applicable billing system

Additional Information

All your information will be kept confidential according to EEO guidelines.

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