Laboratory Scientist/MLS/CLS/MT Billing Specialist - Pathology Administration - Days

Essential Job Statements

Billing and Coding: Assess and interprets laboratory reports to ensure correct CPT codes are charged in a timely manner. Performs coding for clinical pathology and outreach areas. Interprets narrative reports to obtain diagnostic codes, modifiers and qualifying circumstances. Resolves weekly claim edits received from MCVH Develops working relationships and serves as liaison with LIS, Patient Accounting, charge services and other parties involved in Outreach Billing team. Resolves worklist and hold bill edits. Resolves weekly claim edits received from MCVH Develops working relationships and serves as liaison with LIS, Patient Accounting, charge services and other parties involved in Outreach Billing team. Resolves worklist and hold bill edits. Reviews, processes and adjusts Pathology charge edits in Cirius. Obtains missing information from clients, may include phone calls, tracking down requisitions and using a combination of systems.

Quality Control/Audit/Issue Resolution: Resolves all transactions editing system (TES) edits for lack of referral or preauthorization by utilizing both MCVH and MCVP billing systems. Responds to all requests from MCVH and MCVP on denied/pending charges by determining whether additional information will resolve the claim or adjustment of the claim is warranted. Assists patients referred to the department responding to billing problems. Participates in quality improvement projects and makes recommendations for process improvements. Performs monthly analysis of charges and Outreach invoices by departments and/or location to determine issues that may impact reimbursement. Brings billing issues to the attention of the Pathology Reimbursement Improvement Committee Tracks, investigates and resolves patient order issues and fatal errors. Investigates duplicate MRN and resolves with appropriate documentation through HIM Completes special projects as directed by the Manager/Director.

Technical Resource/Communication/Customer Relations: Performs as the technical and expert coding resource to billing staff, lab departments and hospital accounting to obtain information or clarification on accurate coding and documentation standards, guidelines and regulatory requirements. Responds to inquiries from physicians and staff, researches and resolves problems related to coding and billing. Works closely with division chairs, physicians, administrators, third party payers and central billing.

Compliance and Safety: Maintains compliance with all applicable regulatory reimbursement requirements. Participates in educational activities with regard to billing compliance. Maintains a high level of understanding of regulatory issues through journals and publications, educational activities, networking and professional/specialty associations. Reviews regulatory agency checklists (CAP, AABB, TJC, FSA, etc.) for updates and assists in implementing as appropriate to meet accreditation guidelines.

Miscellaneous Responsibilities: Performs other duties as assigned and/or participates in special projects in order to support the mission of VCUHS and the Department. Provides assistance to team members. Accepts alternate assignments, as required. Supports the department in a wide variety of logistical support functions

Patient Population: Neonates (0-4 weeks), Infant (1-12 months), Pediatrics (1-12 years), Adolescents (13-17 years), Adults (18-64 years), Geriatrics (65 years and older)

Employment Qualifications

Required Education: Bachelor's Degree in Clinical Laboratory Science (BSCLS) from an accredited program OR a Bachelor's Degree in a Biological Science* in addition to graduation from an NAACLS-accredited CLS/MT certificate program OR Bachelor's Degree in a Biological Science with 8 or more years of on the job training in a hospital health care environment in a specific lab discipline performing high complexity testing in blood banking, chemistry, hematology, microbiology, immunology and clinical microscopy (categorical or generalist certification required).

Preferred Education: Master's Degree in Clinical Lab Science (MSCLS) from an accredited program

Licensing/ Certification

Licensure/Certification Required: Licensure/Certification Required: Certified as a Medical Technologist (MT) or Medical Laboratory Scientist (MLS) by the American Society for Clinical Pathology (ASCP) or Clinical Laboratory Scientist (CLS) by the National Credentialing Agency (NCA) or equivalent ASCP Specialty or Categorical certification. Team Members with required Credential Maintenance: technical positions that require certification maintenance, team members must obtain the number CE hours as required by The Board of Certification Credential Maintenance Program (CMP).

* Coding Certification required within 18-months of hire into the position: Certified Procedural Coder (CPC) by the American Academy of Procedural Coders, or Certified Coding; Specialist Physician- based (CCS-P) by the American Health Information Management Association, or Equivalent/comparable coding certification

Licensure/Certification Preferred: MT/MLS/CLS ASCP and Certified Procedural Coder

Minimum Qualifications

Years and Type of Required Experience: Minimum of three (3) years of clinical work experience as a Medical Technologist. Depending on the laboratory assignment, work experience requirement may be specific to a particular specialty areas such as Microbiology, Immunology, Molecular Biology, Transfusion Medicine, Clinical Chemistry, Toxicology, etc.

Other Knowledge, Skills and Abilities Required: Excellent technical, communication (written and verbal) and computer skills

Cultural Responsiveness: N/A

Other Knowledge, Skills and Abilities Preferred: Three (3) years of experience in medical billing environment, coding and reimbursement. Previous experience with third party reimbursement policies and procedures and medical billing application

Working Conditions: Periods of high stress and fluctuating workloads may occur. General office environment. May be exposed to adverse weather conditions; cold, hot, dust, wind, etc. May be exposed to high noise levels and bright lights. May be exposed to limited hazardous substances or body fluids. * May be exposed to human blood and other potentially infectious materials. * May have periods of constant interruptions. Prolonged periods of working alone.

* Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.

Physical Demands: Lifting/ Carrying (0-50 lbs.), Push/ Pull (0-50 lbs.), Bending

Work Position: Sitting, Walking, Standing

Additional Physical Requirements/ Hazards

Physical Requirements: Manual dexterity (eye/hand coordination), Hear alarms/telephone/tape recorder, Reach above shoulder, Repetitive arm/hand movements, Finger Dexterity, Color Vision, Acuity - far, Acuity - near

Hazards: Depth perception, Use of Latex Gloves, Exposure to toxic/caustic/chemicals/detergents, Exposure to moving mechanical parts, Exposure to dust/fumes, Exposure to high pitched noises

Mental/Sensory -Emotional
Mental/Sensory: Strong recall, Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical thinking
Emotional: Fast pace environment, Steady Pace, Able to handle multiple priorities, Frequent and Intense Customer Interactions, Noisy Environment, Able to adapt to frequent change

EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.