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Position Summary: 

Under the general supervision of the Client Services Manager, Client Services will review, update, and maintain established work standards to maximize productivity within the revenue cycle and Client Services. Client Services may be asked to assist in accessioning for clinical and pathology testing. Client Services will assist in answering incoming calls, and emails, maintaining all 3rd party testing, and other duties required by the Client Service manager.

Client Services will assist the Accessioning Supervisor and Client Services Manager in assigning work assignments to ensure appropriate coverage and delegate as needed. Will act as a liaison between the business office, clinic, and lab to ensure all internal and external customer service needs are addressed. Client Services will review medical insurance policies on incoming shipments and utilize the Insurance Matrix and Provider Billing Report to ensure proper test routing for both in-house testing and send-outs. Will work with the Utilization Management (UM) team to obtain authorizations when required to perform in-house pathology testing. Will assist revenue cycle in reviewing various BI reports and addressing denials, and claims resubmissions as needed.

Client Services I will assist with monthly quality assurance reports.  Client Services will use and maintain a proper communication platform for both internal and external customer service and update as necessary. Client Services will assist as needed with all accessioning duties which include packing and unpacking pathology specimens, reviewing specimen quality to ensure they are properly labeled and that critical information on the label matches information on the requisition, accessions the specimen in the Lab Information System (LIS) distributes specimens to the appropriate laboratory section, and continues to gain knowledge of specimens and their adequacy for testing. Will organize and maintain the lab area by performing a variety of clerical, technical, and administrative tasks.

Key Performance Areas

Clinic and Laboratory Support

• Handles all customer inquiries received by telephone, fax, and email regarding reporting of patient results, inquiries of test and services, concerns of service failures and other duties to provider superior service.
• Report laboratory results to providers using established protocols
• Document reporting and call history in required format and maintain complete and accurate records.
• Assists in resolving routine matters related to patient testing and result reporting.
• Report client concerns using the established protocols.
• Provides education and updates pertaining to laboratory processes.
• Understands the importance of Quality Service and how it is measured.
• Performs other duties as required to meet the customer requirements
• Assists with Accessioning as needed and maintains proper training required to perform accessioning tasks.

Analysis and Reporting

• Verifies that all executed authorizations and insurance verification have been received, scanned and that documents are maintained in the EMR, and billing database is updated.
• Extract scheduling reports to review routing, auth requirements, and follow up on changes to shipping and ordering.

Auditing

• Prepares and reviews test routing reports and volumes reports monthly
• Prepares and reviews denial reports monthly
• Reviews and maintains inhouse testing menus and clinic contact lists.
• Reviews inhouse and send out cases to ensure TAT meets standard procedures.

Billing

• Assists with claims processing to ensure appropriate laboratory reports are uploaded into the EMR
• Reviews pathology cases for appropriate diagnosis codes and updates accordingly
• Reviews clinical billing to ensure appropriate diagnosis codes are updated and used according to guidelines.
• Liaison between laboratory, clinic, and reference laboratories to ensure timely claims processing by reviewing problem holds. 
• Screen test orders to ensure proper auth is on file and compatible/ proper ICD codes used for processing.
• Submits billing for SPEP and electrophoresis testing and uploads results into ONCO EMR.

Job Qualifications and Requirements

Education

High School Diploma Required; Bachelor’s Degree Preferred

Experience

• 1-2 years in a medical billing and/or laboratory environment
• Experience in medical and/or laboratory setting with an understanding of medical/laboratory terminology required.
• 1-2 years’ experience with insurance authorization and benefit investigation required. Students seeking Bachelor of Science Degree in Biology, Chemistry, Molecular Biology, or related field desirable.
• Candidate must demonstrate dependability, flexibility, and adaptability in all aspects of laboratory responsibilities and scheduling hours and have a general understanding of insurance billing if applicable.

Certifications/Licenses

• CCA (Certified Coding Associate), CCS (Certified coding Specialist) or CPC certification (Certified Professional Coder) Preferred but not required.

Core Capabilities

• Analysis & Critical Thinking: Critical thinking skills including solid problem-solving, analysis, decision-making, planning, time management and organizational skills. Must be detailed oriented with the ability to exercise independent judgment.
• Interpersonal Effectiveness: Developed interpersonal skills, emotional intelligence, diplomacy, tact, conflict management, delegation skills, and diversity awareness. Ability to work effectively with sensitive and confidential material and sometimes emotionally charged matters.
• Communication Skills: Good command of the English language. Second language is an asset but not required. Effective communication skills (oral, written, presentation) is an active listener, and effectively provides balanced feedback.
• Customer Service & Organizational Awareness: Strong customer focus. Ability to build an engaging culture of quality, performance effectiveness and operational excellence through best practices, strong business and political acumen, collaboration, and partnerships, as well as a positive employee, physician and community relations.
• Self-Management: Effectively manages own time, conflicting priorities, self, stress, and professional development. Self-motivated and self-starter with ability work independently with limited supervision. Ability to work remotely effectively as required.  
• Must be able to work effectively in a fast-paced, multi-site environment with demonstrated ability to juggle competing priorities and demands from a variety of stakeholders and sites.

Computer Skills

• Proficiency in MS Office Word, Excel, Power Point, and Outlook required.

Travel: No

Standard Core Workdays/Hours: Monday-Friday 30-40 hours required (FTE).

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