P4P
Responsibilities
Review and scrub claims prior to submission to ensure all patient, provider, CPT, and diagnosis information is accurate and complete. Validate CPT and ICD-10 codes for accuracy and medical necessity in accordance with payer and CMS guidelines. Identify claim errors, discrepancies, or missing data and coordinate with internal and external teams (including outsourced billing teams, sales reps, clinical teams, phlebotomists, and lab IT) to correct and resubmit. Maintain up-to-date knowledge of payer-specific policies, modifiers, LCD/NCD coding rules, and compliance standards for molecular and diagnostic testing. Work cross-functionally to ensure claims are optimized for clean submission and prevent denials or delays. Prepare summary reports and performance metrics for stakeholders and leadership, highlighting recurring issues or process improvements. Support internal training and provide feedback loops to ensure ongoing coding accuracy and RCM process efficiency. Qualifications
2+ years of experience in RCM, medical billing, or coding (laboratory experience strongly preferred). Strong working knowledge of CPT, ICD-10, and HCPCS coding, particularly within molecular diagnostics, toxicology, and women’s health. Familiarity with claim scrubbing software, EHRs, and clearinghouses. Understanding of payer policies, prior authorization workflows, and claim submission protocols. Experience collaborating with multi-departmental teams and external partners. Certification such as CPC, COC, or equivalent preferred but not required. Personal Skills
Detail-oriented with strong analytical and problem-solving skills. Excellent written and verbal communication. Ability to manage multiple priorities and meet tight deadlines. Proactive mindset with a passion for accuracy and compliance. Self-driven, reliable, and comfortable working both independently and collaboratively. Work Location: In person
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Review and scrub claims prior to submission to ensure all patient, provider, CPT, and diagnosis information is accurate and complete. Validate CPT and ICD-10 codes for accuracy and medical necessity in accordance with payer and CMS guidelines. Identify claim errors, discrepancies, or missing data and coordinate with internal and external teams (including outsourced billing teams, sales reps, clinical teams, phlebotomists, and lab IT) to correct and resubmit. Maintain up-to-date knowledge of payer-specific policies, modifiers, LCD/NCD coding rules, and compliance standards for molecular and diagnostic testing. Work cross-functionally to ensure claims are optimized for clean submission and prevent denials or delays. Prepare summary reports and performance metrics for stakeholders and leadership, highlighting recurring issues or process improvements. Support internal training and provide feedback loops to ensure ongoing coding accuracy and RCM process efficiency. Qualifications
2+ years of experience in RCM, medical billing, or coding (laboratory experience strongly preferred). Strong working knowledge of CPT, ICD-10, and HCPCS coding, particularly within molecular diagnostics, toxicology, and women’s health. Familiarity with claim scrubbing software, EHRs, and clearinghouses. Understanding of payer policies, prior authorization workflows, and claim submission protocols. Experience collaborating with multi-departmental teams and external partners. Certification such as CPC, COC, or equivalent preferred but not required. Personal Skills
Detail-oriented with strong analytical and problem-solving skills. Excellent written and verbal communication. Ability to manage multiple priorities and meet tight deadlines. Proactive mindset with a passion for accuracy and compliance. Self-driven, reliable, and comfortable working both independently and collaboratively. Work Location: In person
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