Lab Coding and Billing Specialist

2 days ago

Davao City, Davao, Philippines OfficePartners, 360 Inc. Full time ₱250,000 - ₱500,000 per year
Job Summary:

The Lab Coding and Billing Specialist is responsible for accurately coding and billing laboratory procedures to ensure timely, compliant, and complete claim submissions. This role involves reviewing patient lab results, assigning appropriate billing codes, verifying charges, and coordinating with internal teams and insurance providers to maintain billing accuracy and compliance.

Key Responsibilities:

  • Billing and Coding: Assign accurate CPT, ICD, and HCPCS codes for laboratory procedures such as biopsies, blood tests, specialized tests, and cytology reports.
  • Claim Processing: Prepare, submit, and track insurance claims to ensure timely and accurate reimbursements.
  • Data Matching: Match unmatched lab results to corresponding patient accounts, ensuring all services are billed correctly.
  • Duplicate Prevention: Review billing entries and verify that no duplicate claims are submitted.
  • Denial Management: Investigate denied or rejected claims, prepare appeals, and follow up to secure reimbursement.
  • Insurance Verification: Verify patient insurance coverage and eligibility before billing to ensure compliance with payer requirements.
  • EOB Review: Review Explanations of Benefits (EOBs) and correct any coding or billing errors as needed.

  • Communication and Coordination:

  • Communicate with insurance companies and patients to resolve billing or claim discrepancies.

  • Coordinate with internal departments regarding pending lab reports, billing issues, and reimbursement status.

  • Reporting and Documentation:

  • Maintain accurate billing and collection records.

  • Create and analyze denial reports by insurance type to identify trends and recommend process improvements.
  • Update reimbursement tracking spreadsheets and reconcile charges versus reimbursements.
  • Prepare and submit regular billing performance reports to management.

  • Team Collaboration:

  • Supervise and monitor coding activities to ensure timely and accurate task completion.

  • Review and validate the work of coders and billers for accuracy and compliance.
  • Coordinate with relevant departments to ensure proper requisition creation and documentation.
  • Update and maintain requisition tracking spreadsheets as needed.

  • Compliance and Continuous Improvement:

  • Stay updated on billing and coding regulations for all insurance carriers.

  • Ensure adherence to HIPAA and internal confidentiality standards.
  • Identify and recommend improvements in billing and coding workflows.

  • System Updates:

  • Update patient accounts with laboratory images and results when necessary.

  • Maintain accurate digital records for audits and reporting.
Qualifications:
  • 2–3 years of experience in medical billing and coding, preferably within a laboratory or healthcare BPO environment.
  • Proficiency in CPT, ICD-10, and HCPCS coding systems.
  • Strong understanding of insurance claim processing and healthcare reimbursement cycles.
  • Working knowledge of HIPAA and data privacy requirements.
  • Experience using EMR systems and billing software.
  • Proficiency in Microsoft Excel for report and spreadsheet management.
  • Excellent attention to detail, analytical, and organizational skills.
  • Strong written and verbal communication abilities.
  • Certification in Medical Billing and Coding (CPC, CCA, or equivalent) is an advantage.
  • Willingness to work on flexible or shifting schedules, including weekends or holidays if required.

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