The Spine Hospital of Louisiana
Hospital Revenue Cycle Specialist - Lab
The Spine Hospital of Louisiana, Baton Rouge, Louisiana, us, 70873
2 days ago Be among the first 25 applicants
POSITION SUMMARY The Hospital Revenue Cycle Specialist – Lab serves as the primary connection between the Laboratory, Revenue Cycle, Registration, and Ordering Providers. This position is responsible for ensuring accurate front-end processes for laboratory patients—including registration, insurance verification, and medical necessity/ABN workflows—while also supporting downstream billing, coding, reimbursement, and denial management. The role requires a strong understanding of lab operations, CPT/HCPCS and ICD-10 coding, ABN regulations, payer policies, and the communication skills necessary to collaborate with physicians and clinical staff.
ESSENTIAL JOB FUNCTIONS Lab Revenue Cycle & Billing Support
Review lab orders for completeness, accuracy, and compliance with payer and Medicare requirements.
Validate correct CPT/HCPCS coding and ICD-10 diagnosis alignment for laboratory tests.
Work closely with coders and billing teams to address lab‑specific edits, claim holds, and documentation needs.
Prepare and present lab‑related denial trends, root‑cause issues, and corrective action recommendations.
Serve as the primary point of contact for lab claim denials, including medical necessity, bundling, coverage, and documentation‑related denials.
Monitor payer policies impacting lab billing and communicate updates to lab, revenue cycle, and clinical teams.
Physician & Provider Engagement
Collaborate directly with ordering providers and their staff to resolve diagnosis code and documentation issues that affect coverage or reimbursement.
Provide education to physicians regarding medical necessity requirements, ABN rules, and documentation needed for successful claim submission.
Serve as liaison between the lab and referring clinics to streamline workflows and reduce recurring denial patterns.
Compliance & Quality Assurance
Ensure adherence to Medicare ABN rules, national and local coverage determinations (NCD/LCD), and payer‑specific lab coverage policies.
Maintain working knowledge of lab workflows, testing requirements, and specimen/order prerequisites.
Participate in audits, quality improvement initiatives, and corrective action plans related to laboratory revenue cycle performance.
Assist in training registration and lab staff on process updates and billing requirements.
Reporting & Performance Monitoring
Track daily, weekly, and monthly lab registration accuracy, ABN completion rates, medical necessity failures, and denial volumes.
Identify trends, provide analysis, and partner with the Revenue Cycle leadership to implement process improvements.
Support departmental KPI tracking and reporting for lab‑related revenue cycle metrics.
Front‑End Patient Access Responsibilities
Perform accurate patient registration for lab services, ensuring complete demographic, insurance, and financial information.
Conduct insurance verification and eligibility checks for all scheduled and walk‑in lab patients.
Validate medical necessity and capture ABN requirements when applicable.
Ensure collection and documentation of patient liability amounts, deductibles, coinsurance, and prior balances when appropriate.
Support daily lab patient workflow, coordinating with phlebotomy and clinical staff to minimize wait times and improve patient experience.
Perform other duties as assigned.
Disclaimer:
The statements above are intended to describe the general nature and level of work performed by individuals assigned to this position. They are not intended to be an exhaustive list of all responsibilities, duties, or skills required. Additional duties may be assigned as needed to support the organization’s ongoing operations and mission.
Requirements Education
High school diploma or equivalent required.
Experience – Required
2–3 years of experience in revenue cycle, patient access, laboratory operations, or medical billing/coding.
Working knowledge of CPT/HCPCS codes, ICD-10 coding, and medical necessity requirements; laboratory billing experience preferred.
Familiarity with Medicare ABN regulations and payer coverage policies related to laboratory services.
Experience with insurance verification and patient registration workflows.
Strong communication skills with the ability to work effectively with physicians, clinical staff, and patients.
Experience – Preferred
Experience in a hospital or ambulatory care laboratory environment.
Prior experience with denials management and payer follow‑up.
Proficiency with EMR and revenue cycle information systems, including registration, billing, and reporting modules.
Licenses/Certificates
Certified Professional Coder (CPC) or Certified Revenue Cycle Representative (CRCR) preferred, but not required.
Skills & Competencies
Detail‑oriented, accurate, and able to problem‑solve complex revenue cycle issues.
Strong analytical skills and ability to interpret coverage guidelines.
Excellent interpersonal and communication skills, including provider‑level communication.
Ability to manage competing priorities and maintain professionalism in a fast‑paced environment.
Commitment to compliance, quality, and positive patient experience.
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, marital status, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by federal, state, or local law.
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POSITION SUMMARY The Hospital Revenue Cycle Specialist – Lab serves as the primary connection between the Laboratory, Revenue Cycle, Registration, and Ordering Providers. This position is responsible for ensuring accurate front-end processes for laboratory patients—including registration, insurance verification, and medical necessity/ABN workflows—while also supporting downstream billing, coding, reimbursement, and denial management. The role requires a strong understanding of lab operations, CPT/HCPCS and ICD-10 coding, ABN regulations, payer policies, and the communication skills necessary to collaborate with physicians and clinical staff.
ESSENTIAL JOB FUNCTIONS Lab Revenue Cycle & Billing Support
Review lab orders for completeness, accuracy, and compliance with payer and Medicare requirements.
Validate correct CPT/HCPCS coding and ICD-10 diagnosis alignment for laboratory tests.
Work closely with coders and billing teams to address lab‑specific edits, claim holds, and documentation needs.
Prepare and present lab‑related denial trends, root‑cause issues, and corrective action recommendations.
Serve as the primary point of contact for lab claim denials, including medical necessity, bundling, coverage, and documentation‑related denials.
Monitor payer policies impacting lab billing and communicate updates to lab, revenue cycle, and clinical teams.
Physician & Provider Engagement
Collaborate directly with ordering providers and their staff to resolve diagnosis code and documentation issues that affect coverage or reimbursement.
Provide education to physicians regarding medical necessity requirements, ABN rules, and documentation needed for successful claim submission.
Serve as liaison between the lab and referring clinics to streamline workflows and reduce recurring denial patterns.
Compliance & Quality Assurance
Ensure adherence to Medicare ABN rules, national and local coverage determinations (NCD/LCD), and payer‑specific lab coverage policies.
Maintain working knowledge of lab workflows, testing requirements, and specimen/order prerequisites.
Participate in audits, quality improvement initiatives, and corrective action plans related to laboratory revenue cycle performance.
Assist in training registration and lab staff on process updates and billing requirements.
Reporting & Performance Monitoring
Track daily, weekly, and monthly lab registration accuracy, ABN completion rates, medical necessity failures, and denial volumes.
Identify trends, provide analysis, and partner with the Revenue Cycle leadership to implement process improvements.
Support departmental KPI tracking and reporting for lab‑related revenue cycle metrics.
Front‑End Patient Access Responsibilities
Perform accurate patient registration for lab services, ensuring complete demographic, insurance, and financial information.
Conduct insurance verification and eligibility checks for all scheduled and walk‑in lab patients.
Validate medical necessity and capture ABN requirements when applicable.
Ensure collection and documentation of patient liability amounts, deductibles, coinsurance, and prior balances when appropriate.
Support daily lab patient workflow, coordinating with phlebotomy and clinical staff to minimize wait times and improve patient experience.
Perform other duties as assigned.
Disclaimer:
The statements above are intended to describe the general nature and level of work performed by individuals assigned to this position. They are not intended to be an exhaustive list of all responsibilities, duties, or skills required. Additional duties may be assigned as needed to support the organization’s ongoing operations and mission.
Requirements Education
High school diploma or equivalent required.
Experience – Required
2–3 years of experience in revenue cycle, patient access, laboratory operations, or medical billing/coding.
Working knowledge of CPT/HCPCS codes, ICD-10 coding, and medical necessity requirements; laboratory billing experience preferred.
Familiarity with Medicare ABN regulations and payer coverage policies related to laboratory services.
Experience with insurance verification and patient registration workflows.
Strong communication skills with the ability to work effectively with physicians, clinical staff, and patients.
Experience – Preferred
Experience in a hospital or ambulatory care laboratory environment.
Prior experience with denials management and payer follow‑up.
Proficiency with EMR and revenue cycle information systems, including registration, billing, and reporting modules.
Licenses/Certificates
Certified Professional Coder (CPC) or Certified Revenue Cycle Representative (CRCR) preferred, but not required.
Skills & Competencies
Detail‑oriented, accurate, and able to problem‑solve complex revenue cycle issues.
Strong analytical skills and ability to interpret coverage guidelines.
Excellent interpersonal and communication skills, including provider‑level communication.
Ability to manage competing priorities and maintain professionalism in a fast‑paced environment.
Commitment to compliance, quality, and positive patient experience.
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, marital status, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by federal, state, or local law.
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