Laboratory Billing Representative

HepQuant is a clinical laboratory with headquarters in Denver and a CLIA-accredited lab in Aurora, Colorado. HepQuant develops minimally invasive, blood-based quantitative tests that measure liver health. Our tests deliver information about liver cell function and portal-systemic shunting, attributes of liver disease that are associated with clinical outcomes. Results may be used by a physician in conjunction with clinical evaluation and other tests to aid clinical management

Job Duties

HepQuant is seeking a dedicated and motivated individual that is comfortable working in a fast-paced, high-volume environment to join the Billing Department team as a Laboratory Billing Representative. They will be responsible for entering the laboratory requisition data to be processed for our clinical laboratory in accordance with established standard operating procedures. The Laboratory Billing Representative will be responsible for accurate billing details, provider credentialing and other day-to-day billing operations. This position requires healthcare billing experience. The ideal candidate will have recent experience in laboratory diagnostics, with a working understanding of all functions including order entry, claims submissions, denials, appeals, customer service and collections. Candidates must have a clear understanding of CPT/ICD-10 coding, commercial and government insurance payer behaviors, payer policies, enrollment procedures, HIPAA and PHI compliance, patient collections and client billing procedures. This candidate will be responsible for working closely with our Revenue Cycle Director (RCD) and vendor (Quadax) to help facilitate prompt claim adjudication and payment. This position will report to the Revenue Cycle Director.

Responsibilities

• Perform the daily operation of the Front-End Billing business functions and some client billing.
• Ensure proper and complete patient information for billing purposes and enter patient information into Salesforce and the LIMs system.
• Complete/Process Provider Credentialing Applications for applicable Health Plans, PPO/Rental Networks, Medicaid FFS States and other entities.
• Make calls to patients to discuss potential financial responsibility as needed.
• Schedule specimen collection appointments, when applicable.
• Interact with customers (patients) and providers to gather support data to ensure invoice accuracy and work through specific billing discrepancies.
• Work closely with Client Services, Sales, Lab professionals and other key departments in a collaborative manner.
• Navigate multiple insurance verification websites to verify patient eligibility.
• Assist with patient assistance program and outstanding balances and take appropriate actions to ensure payment collected.
• Review all work for validity of data entered.
• Work with Client Services to resolve and document all discrepancies found on test order requisitions.
• Review reports of current billing holds and resolves them in a timely fashion to ensure prompt payment.
• Ensure customer privacy is always maintained.
• Interface with external billing vendor to address issues or tasks to facilitate claim adjudication.
• Execute and manage medical records request process (outreach, posting, follow up).
• Support the appeal process of denied claims.
• Follow guidelines and comply with all company safety, quality, and training procedures and regulations.
• Compliant with all Federal, State and HIPAA and PHI laws and regulations. Compliant with company policies, directives and Medicare rules and regulations.
• Perform other duties, as assigned.

Regulatory Requirements

This role shall comply, at a minimum, with the responsibilities outlined in:

• CLIA: Clinical Laboratory Improvement Amendments (CLIA) Requirements, Title 42 Code of Federal Regulations Part 493
• CAP: College of American Pathologists (CAP): All Common, General, Chemistry, Director Responsibility and Authority and Molecular Pathology checklists
• ISO: International Organization for Standardization (ISO) 13485, Quality Management Systems, Requirements for Regulatory Purposes, 2016
• All other applicable state and regulatory governing authorities including but not limited to: CA, PA, RI, MD, WA Medical Test Site (MTS)

Qualifications

• Education: Requires a High School diploma or equivalent; Associates or Bachelors' degree, preferred.

Skills and experience

• 0-2 years of direct billing experience in a lab setting desired.
• Experience within diagnostics, medical device, biopharma, biotech, healthcare, or related life sciences industry is ideal.
• Prior call center experience is highly preferred.
• Experience with Billing vendors like Quadax, Xifin, Telcor and LIMS (laboratory information management system) a plus.
• Experience with healthcare cash application and claims processing required.
• Working knowledge of Microsoft Word, Excel, and Outlook are required.

Knowledge, Skills, and Abilities:

• Experience with CPT/PLA codes, national and local Medicare billing rules, and medical insurances.
• Knowledge of basic laboratory and phlebotomy terminology along with clinical laboratory safety procedures.
• Experience dealing with Medicare, Commercial Covered and other payors.
• Strong listening skills and professional oral & written communication skills with an ability to inspire trust and accountability though an empathetic communication style.
• Working knowledge of billing vendors, Salesforce and laboratory information management system (LIMS) a plus.
• Possess the ability to read, write, and speak English language. Must have legible handwriting.
• Strong interpersonal interaction and communication skills and demonstrable ability to work collaboratively at all levels within the HepQuant organization.
• Skilled in anticipating and resolving issues.
• Excellent attention to detail, time management and process management.
• Proficient in the use of computer applications and software, including Microsoft Word, Excel, and Outlook, and use of telephones, copiers, and fax machines.
• Able to perform a wide variety of tasks and multi-task efficiently.
• Customer service skills for interacting with patients regarding resolution of medical claims and payments.
• Ability to work well in a team environment.
• A calm manner, patience and professional behavior at all times while working with patients, insurers, internal and external partners.
• Understanding of legal and ethical issues concerning patient confidentiality (HIPAA).
• Ability to handle high volume of work accurately and under stress and time constraints.

Key Attributes

• Drive and determination
• Ability to work in a fast-paced and dynamic environment.
• A positive attitude demonstrated during company functions and public events to encourage team camaraderie and enthusiasm for growth in market share and revenue.
• Self-starter
• Driven to perform.
• Self-directed: needs little explicit direction and no hand holding
• Able to organize, prioritize, and delegate tasks to efficiently move projects forward.