Lab Billing Specialist

Job Description

Job Description

Job Purpose:

The Lab Billing Specialist is responsible for accurate and timely billing of laboratoryservices, ensuring compliance with payer guidelines, regulatory requirements, and organizationalpolicies. This role works closely with clinical, coding, and revenue cycle teams to resolve billing issues,maximize reimbursement, and reduce denials.

1. Claims Processing & Submission

● Prepare, review, and submit laboratory clean claims to payers across all lines of business

● Verify coding accuracy and required documentation prior to billing

● Correct and resubmit rejected or returned claims

2. Accounts Receivable Tier 1

● Monitor outstanding AR and follow up on unpaid or underpaid claims

● Contact payers to resolve claim issues, discrepancies, or delays

● Document all follow‑up activity in the billing system

3. Payment Posting & Reconciliation

● Post insurance and patient payments accurately

● Reconcile EOBs/ERAs and identify variances

● Escalate payment discrepancies or trends to leadership

4. Denial Management

● Review and analyze denial reasons

● Prepare corrected claims or appeal packets as needed

● Collaborate with UR, coding, and clinical teams to prevent recurring denials

5. Compliance & Quality

● Ensure all verification processes follow payer guidelines and internal SOPs. Identify trends incoverage issues and recommend process improvements. Protect patient privacy and maintainHIPAA compliance at all times.

Education and experience, degree and/or certification required (if applicable):

1. Education and Experience:

● High school diploma or equivalent required; associate’s or bachelor’s degree in

● business, finance, or related fields preferred.

● Minimum of 1-3 years of experience in medical billing, collections, RCM, or healthcare finance.2+ years of medical or laboratory billing experience

● CPC, CBCS or CPB certification are strongly preferred.

2. Skills and Abilities:

● Strong understanding of insurance claim processes EOBs,CPT/HCPC, ICD-9/10 and reimbursement policies.

● Familiarity with electronic medical records (EMR) and billing software.

● Excellent analytical, organizational, and problem-solving skills.

● Strong communication skills, both verbal and written.

● Ability to work independently and manage multiple tasks effectively.

● Experience with commercial insurance, Medicare, and Medicaid billing guidelines

● Familiarity with clearinghouses and EDI claim submission