Laboratory Revenue Integrity Specialist

St. Charles Health System•Bend, OR

1d•$25 - $38

About The Position

The Laboratory Revenue Integrity Specialist at St. Charles 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.

Requirements

High school diploma or GED.
Coding Certification of one or more of the following RHIT, RHIA, CPC, CCS, within one year of hire.
Maintains required educational credits (CE).
Minimum of three years’ experience working in a medical or hospital laboratory setting.
Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely.
Must demonstrate above average judgment, discretion, critical thinking, and technical skill.
High to moderate computer skills.
Strong working knowledge of laboratory operations and hospital and laboratory health information systems.
Demonstrated ability and experience in computer applications, specifically MS Office
Must have excellent communication skills and ability to interact with a diverse population and professionally represent St. Charles Health System.
Strong teamwork and collaborative skills.
Ability to effectively reach consensus with a diverse population with differing needs.
Ability to manage facilitation and consensus building among health care professionals and agencies and achieve expected results.
Ability to work under pressure in a fast-paced environment.
Ability to multi-task and work independently.
Attention to detail.
Excellent organizational skills, written and oral communication, and customer service skills, particularly in dealing with stressful personal interactions.
Strong analytical, problem solving and decision-making skills.
Experience using multiline phones.
Continually (75% or more): Use of clear and audible speaking voice and the ability to hear normal speech level.
Frequently (50%): Sitting, standing, walking, lifting 1-10 pounds, keyboard operation.

Nice To Haves

Associate or Bachelor’s degree in Health information or Healthcare Administration, or related courses.
Current certification of (RHIT, CPC, CCS), maintains required education credits (CE).
Three or more years in Laboratory billing/audits, billing edits, and resolutions in health system setting including CPT/HCPC codes, medical terminology, or medical coding and insurance billing for medical services.

Responsibilities

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