Pre Billing Specialist I

Job Description

Job Description

Full-Time | On Site/In person | Woodland Hills, CA | M-F/ 8:00 a.m. - 5:00 p.m. EST, CT and PST

Position Summary

The Pre-Billing Specialist I is responsible for supporting the laboratory revenue cycle by ensuring accurate and complete claim preparation prior to submission. This role focuses on reviewing, validating, and correcting patient, insurance, and test order information to produce clean claims and minimize denials. The ideal candidate is detail-oriented, organized, and able to work within established workflows to meet productivity and quality standards.

Key Responsibilities

Pre-Billing & Claim Preparation

• Review laboratory orders and associated documentation for completeness and accuracy prior to billing
• Validate patient demographics, insurance information, and provider details
• Identify and correct errors that may prevent successful claim submission

Data Verification & Quality Control

• Ensure all required elements for claim submission are present, including diagnosis codes and test codes
• Apply basic medical necessity guidelines and flag discrepancies
• Work assigned pre-bill edits and queues within billing systems

Charge & Coding Support

• Assist with charge entry validation to confirm alignment between performed tests and billable services
• Verify correct CPT/HCPCS codes are applied based on established guidelines
• Escalate complex coding or medical necessity issues to senior team members

Workflow & System Use

• Utilize laboratory information systems (LIS), billing systems, and clearinghouse tools
• Maintain productivity standards for volume and turnaround time
• Follow standardized workflows and payer-specific requirements

Collaboration & Issue Resolution

• Partner with accessioning, coding, and billing teams to resolve discrepancies
• Communicate clearly regarding missing or conflicting information
• Support denial prevention efforts through proactive issue identification

Required Qualifications

• High school diploma or equivalent
• At least 1 year of experience in healthcare, medical billing, or data entry (lab experience preferred but not required)
• Strong attention to detail and accuracy
• Basic computer and data entry skills
• Ability to follow structured workflows and meet deadlines

Preferred Qualifications

• Exposure to medical billing, revenue cycle, or laboratory operations
• Familiarity with CPT/HCPCS codes, ICD-10 diagnosis codes, or medical terminology
• Experience working with EMR, LIS, or billing systems

Core Competencies

• Detail orientation and accuracy
• Time management and productivity
• Critical thinking and problem-solving
• Communication and teamwork
• Adaptability in a fast-paced, high-volume environment