Job Summary:The purpose of this position is to ensure the appropriate billing and coding of Laboratory Services performed by or for the benefit of KPNW to all payors via the appropriate use of CPT, ICD-9CM, HCPCS codes according to billing compliance rules and regulations and KPNW policies and procedures.Essential Responsibilities:
Accurately identify and verify all CPT, HCPCS, ICD-9CM coding requirements for all Laboratory Services including Pathology. Maintain up to date and accurate CPT and HCPCS coding relative to the Charge Master and fee schedule to ensure appropriate pricing and coding for Laboratory Services, including understanding of and communication with referred test providers utilized by KPNW.
Maintain and research all lab claim error reports and work queues to ensure proper coding and pricing of internal and referred Laboratory testing. Verify patient status, payor type and coverage type to ensure appropriate billing. Maintain and document an ongoing audit and monitoring program for Laboratory billing to ensure accuracy and system data integrity.
Maintain a comprehensive knowledge of Regional, State, Federal, CMS and departmental regulations, statues, policies and procedures. Maintain a high level of communication between Laboratory and other departments to coordinate efforts to ensure compliance and resolve coding and claims discrepancies.
Act as a departmental coding and billing resource for Laboratory and Pathology staff and other KPNW departments. Provide training to ensure overall competency across the laboratory. Develop and produce ongoing reports for routine trending, analysis and identification of problem patterns.
Perform ongoing review and revisions of policies and procedures within the Laboratory to adequately address any and all coding and billing compliance issues, changes or improvements. Act as responsible individual for lab policies and procedures relating to lab billing.
Perform annual and periodic coding review and subsequent updates/changes in conjunction with Compliance and Documentation and Coding departments.
Basic Qualifications:Experience
Three (3) years of experience in Medical Laboratory billing and collections, including contracted and non-contracted insurance, Medicare, Medicaid, and institutional billing, regulatory requirements, including CPT and ICD-9CM coding, and CMS requirements.
Understanding of physician billing and insurance contracts; experience in working with payor denials.
Medical terminology experience.
Laboratory referred test experience.
Extensive computer and telephone experience.
Education
GED or high school diploma or equivalent.
License, Certification, Registration
N/A
Additional Requirements:
Basic knowledge of billing and coding regulations.
Knowledge and applicable understanding of coding techniques for laboratory services (CPT, HCPCS, etc).
Demonstrative 10 key calculator ability.
Excellent verbal and written communication skills.
Demonstrated good attendance.
Excellent organization skills.
Problem solving, listening and conflict resolution skills.
Ability to research and resolve complex billing issues.
Detail oriented with organizational skills which involve the ability to prioritize and manage workflow, produce high quality work, work independently with minimal supervision and the ability to use good judgment.
Knowledge of coding and billing regulations for government and other payors, including the potential for false claims submission or other fraud and abuse situations.
Ability to operate office equipment, i.e., Fax machine, photo copier, printer, etc.
Preferred Qualifications:
Five (5) or more years of experience in Medical Laboratory billing and collections, including contracted and non-contracted insurance, Medicare, Medicaid, and institutional billing, regulatory requirements, including CPT and ICD-9CM coding, and CMS requirements.
Professional coder certification (CPC).
Working knowledge of Kaiser Permanente Health Plan coverage and benefits.
Working knowledge of Kaiser Permanente computer systems and applications.
Working knowledge of Kaiser Permanente organization policies and procedures.
Knowledge of the full range of clinical and anatomic Laboratory tests.
Post high school vocational or business course work.
Notes:
This position is onsite until a flexible work agreement can be established.
COMPANY: KAISERTITLE: Specialist, Lab ChargingLOCATION: Portland, OregonREQNUMBER: 1298508External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.