Laboratory Billing and Coding Senior Specialist

Location: Tampa, Florida US


Job Number: 1347

Position Title: Laboratory Billing and Coding Senior Specialist

External Description:

The Laboratory Billing and Coding Senior Specialist is entrusted with the job of reviewing, auditing, and coding provider’s documentation for the purpose of reimbursement, training, education, and compliance using ICD-10 and CPT codes. The successful applicant will serve as an information resource and guide to our providers, clinical staff, practice managers, members of the Revenue Cycle and Client Services teams and other leadership. This position will be directly involved in analyzing laboratory pre-bill claim edits, claim denials and Accounts receivable (AR) management, and working alongside the Revenue Cycle Specialists, will review and amend laboratory denied claims to ensure accurate coding and adherence to payor policy requirements.  The Laboratory Billing and Coding Senior Specialist will perform proactive audits of medical charts and records for compliance with federal coding regulations and guidelines. This role utilizes knowledge of client systems and procedures to provide a second level review of codes assigned to medical diagnoses and laboratory procedures, ensuring that medical billing conforms to legal and procedural requirements. The Laboratory Billing and Coding Senior Specialist reviews, develops, and/or modifies client procedures, systems, and protocols to achieve and maintain compatibility with billing requirements and compliance


Duties and responsibilities:

  • Conduct claim audit to confirm vendor meeting or exceeding quality metrics
  • Validate charge entry lag to confirm vendor meeting or exceeding SLA
  • Confirm insurance AR >90 is at/under 15% of total AR
  • Confirm DAR at/under 30 days in AR
  • Contact payor to obtain patient benefits if submitted to other labs
  • Apply applicable discount/adjustments to patient responsibility, when requested
  • Review processing of claims on tracking file to confirm paid/denied
  • Review 10% of add-on test claims to confirm if rebilled correctly
  • Full scale or individual claim review to confirm previous directives are followed with regard to CPT/provider/other changes
  • Capture of all claims adjudicated to patient responsibility to remove from patient responsibility and appeal to insurance
  • Post-claim adjudication review of documentation for alternative supporting diagnoses and/or query workflow to ordering physician
  • Retrieval of Athena billing summary for subpoena responses
  • Confirm underpayments and track claims for payor projects w/ escalation to provider rep, when necessary
  • Confirm incorrect denials and track claims for payor projects w/ escalation to provider rep, when necessary
  • Coordinate responses to SIU requests


Position Requirements:

  • Certified Professional Coder (CPC) certification required
  • Previous medical billing experience required
  • Minimum of 3 years’ experience as a biller, collector, coder, auditor, back-office support staff, or other equivalent medical industry experience
  • Ability to travel (as needed)
  • OB/GYN experience preferred, but not required
  • Associates degree from an accredited university preferred
  • Athena experience preferred, but not required
  • Knowledge of auditing concepts and principles
  • Advanced knowledge of medical coding and billing systems and regulatory requirements
  • Ability to use independent judgment and to manage and impart confidential information
  • Ability to analyze and solve problems
  • Strong communication, presentation, and interpersonal skills
  • Knowledge of legal, regulatory, and policy compliance issues related to medical/laboratory coding and billing procedures and documentation
  • Knowledge of current and developing issues and trends in medical coding procedures requirements
  • Ability to clearly communicate medical information to professional practitioners and/or the public
  • Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements
  • Ability to provide guidance and training to professional and technical staff in area of expertise.

City: Tampa

State: Florida

Community / Marketing Title: Laboratory Billing and Coding Senior Specialist

Company Profile:

Unified Women’s Healthcare is a company dedicated to caring for Ob-Gyn providers who care for others, be they physicians or their support staff. A team of like-minded professionals with significant business and healthcare experience, we operate with a singular mindset - great care needs great care. We take great pride in not just speaking about this, but executing on it.

As a company, our mission is to be an indispensable source of business knowledge, innovation and support to the practices in our network. We are advocates for our Ob-Gyn medical affiliates – enabling them to focus solely on the practice of medicine while we focus on the business of medicine.

We are action oriented. We strategize, implement and execute – on behalf of the practices we serve.

Remote Opportunity: 1

EEO Employer Verbiage:

We offer a competitive salary and an excellent benefit package that includes health/dental/life/STD/LTD/vision insurance, paid time off, and 401(k) plan.    This company is a drug-free workplace and an Equal Employment Opportunity employer.

Questions? Contact us:

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