Pre Billing Specialist II

United WestLabs• US,

3d•$26 - $32

About The Position

The Pre‑Billing Specialist II is responsible for advanced pre-claim review, validation, and issue resolution to ensure accurate, compliant, and clean claim submission for laboratory services. This role requires strong knowledge of laboratory billing workflows, payer policies, and medical necessity requirements. The position plays a key role in denial prevention by proactively identifying and resolving complex issues related to coding, eligibility, and documentation prior to claim submission.

Requirements

High school diploma or equivalent
2–5+ years of experience in medical billing, revenue cycle, or laboratory billing
Strong understanding of CPT/HCPCS and ICD-10 coding
Strong understanding of insurance eligibility and coverage rules
Strong understanding of medical necessity requirements (especially lab-specific)
Experience working with billing systems, LIS, EMR, or clearinghouse tools
Ability to analyze and resolve complex billing issues independently

Nice To Haves

Associate or Bachelor’s degree
Laboratory billing or diagnostic services experience (e.g., pathology, genetic testing, reference labs)
Experience with Medicare/Medicaid billing rules and payer-specific policies
Familiarity with Epic (Beaker), Cerner, or comparable systems
CPC (Certified Professional Coder) certification
CPB (Certified Professional Biller) certification

Responsibilities

Perform comprehensive pre-bill review of laboratory claims to ensure accuracy, completeness, and compliance prior to submission
Validate complex patient demographics, insurance coverage, and ordering provider information
Identify trends and recurring issues impacting claim quality and first-pass acceptance
Evaluate diagnosis-to-procedure code alignment using payer-specific guidelines, including Medicare LCD/NCD policies
Review and validate CPT/HCPCS coding for laboratory services, including specialty and high-complexity testing
Identify potential medical necessity denials and ensure appropriate documentation or ABN workflows are applied
Independently resolve complex claim edits and exceptions within billing systems and clearinghouse tools
Research and troubleshoot discrepancies related to eligibility, authorizations, coding, or charge capture
Escalate systemic issues and recommend process improvements
Review charge capture processes to ensure alignment between performed tests and billed services
Support revenue integrity by identifying underbilling, overbilling, or missed charges
Partner with coding and compliance teams on billing accuracy and audit readiness
Monitor and prioritize work queues to meet turnaround time and productivity standards
Conduct quality checks and provide feedback to entry-level staff
Assist in developing and refining standard operating procedures (SOPs)
Work closely with accessioning, coding, billing, and client services teams to resolve pre-bill issues
Serve as a subject matter expert (SME) for pre-billing processes and payer requirements
Support training and onboarding of new team members