Purpose of the Position:
Responsible for management and support of enterprise-wide revenue cycle for billing and reimbursement. Compliance officer responsible for ensuring full Federal and State Compliance.
– Directs and oversees the overall policies, objectives, and initiatives of the organization’s revenue cycle activities to optimize reimbursement and ensure compliance
– Works with Upper Management/Leadership team regularly to discuss plans of action, issues, best practices, and compliance
– Assesses and makes recommendations to improve efficiency of current systems/processes for the entire Revenue Cycle
– Be the main contact point as it pertains to any Revenue Cycle Management questions, concerns, updates.
– Prepare monthly Revenue Cycle reports
– Manages the internal billing staff
– Reviews, designs, and implements processes surrounding billing, pricing, third party payer relations, compliance, collections and other financial analyses to ensure that revenue cycle is effective and properly utilized
– Identify and analyze reimbursement trends to advise Upper Management and internal stakeholders accordingly
– Perform prospective and retrospective chart audits, reviewing for accuracy and compliance
– Work closely with billing vendor and reimbursement staff to address billing issues and streamline workflows
– Work closely with Internal and External Sales Groups to ensure proper guidelines are followed and ensure any questions or concerns as they relate to billing and reimbursement are handled in a timely and efficient manner
– Investigate billing issues due to potentially inappropriate documentation, coding, and/or medical necessity
– Follow up with the referring physician offices and/or Internal/External Sales Groups to ensure corrective actions are taken
– Investigate, evaluate, recommend, and implement coding and fee updates
– Negotiate contracts with payers based on needs of the company
– Perform other administrative and supervisory duties as assigned
Qualifications (knowledge, skills, experience, abilities, and other requirements):
– Bachelor’s Degree or relevant experience required
– 10+ years’ experience Staff Management
– 10+ years’ experience hands on billing & coding required
– Strong understanding of the Revenue Cycle and ability to manage each aspect of it
– Compliance Officer experience a plus
– Experience in a molecular / genomics lab a must have
– Audit Certificate highly preferred
– Strong understanding of the Medical/Laboratory Billing Process and Industry Standard
– Exceptional Knowledge of ICD’s, CPT’s, and LCD’s.
– Must possess strong knowledge of EOB’s and ERA’s with the ability to read and understand the follow-up steps required to mitigate any issues that need attention
– Successful track record of negotiating with insurance companies to be brought in-network
– Highly proficient in Microsoft Office, specifically Excel
– Excellent interpersonal, verbal, and written communication skills
– Ability to multitask and manage several projects concurrently
– Ability to think outside the box
Beyond the Job:
We focus on advanced molecular diagnostics, personalized medicine and non-invasive cancer testing. Our goal is to fulfill unmet medical needs with cost-effective tests and accurate analysis that guide patient care by utilizing next generation sequencing technologies and advanced bioinformatics to redefine disease screening, diagnosis, treatment, monitoring, and management. It is our mission to deliver transformative, valuable solutions for patients, physicians, payers, and clinical researchers.
Our employees have a winning attitude and champion innovation, teamwork and accountability through a results-oriented, customer-centric, and fun culture. We offer various health and financial benefits, learning opportunities, competitive compensation, rewarding bonus programs, and a wide range of work/life benefits designed to make your life easier.
At Lighthouse Lab Services, we offer solutions to help start, grow, and run clinical laboratories. Our recruiting team has more than 17 years of proven success placing job seekers in positions ranging from entry level Medical Technologists to seasoned Laboratory Directors. We recruit nationwide, for permanent and travel positions with clients ranging from small hospitals to large reference laboratories.
It is the policy of Lighthouse Lab Services to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law.
Lighthouse Lab Services | 800-838-0602 | lighthouselabservices.com
#JY Job #12980