Laboratory Business Operations Specialist

Department: PCH-MAIN | Lab Administration • Location: Phoenix • Shift: Mon-Fri, 8 am–5 pm • Full-Time

About the role

This position works in the Business Operations team, serving as a key technical resource while providing strategic guidance and expertise to all laboratory departments. The role is responsible for optimizing prompt and accurate billing for all hospital laboratory and pathology professional billing services, including reviewing system error reports and resolution of billing exceptions, auditing referral lab invoices, developing and maintaining reference testing third-party billing workflows, providing support for clinical and anatomic pathology billing needs, and ensuring laboratory billing is current and appropriate for all testing. The specialist recommends CPT codes for in-house and reference lab testing, provides guidance to Laboratory and Revenue Integrity teams, and monitors healthcare rules and regulation changes to maintain billing compliance. The role partners with hospital billing and finance teams in the development and execution of billing process improvements related to compliance and reimbursement of laboratory testing and the development and maintenance of policies and procedures.

Responsibilities

• Review billing system error reports and resolve billing exceptions.
• Analyze error patterns, identify root causes, and develop systematic solutions; proactively escalate billing issues and insights on new billing trends to the Lab Business Operations, Revenue Integrity, and Compliance teams.
• Provide billing operational support, including error processing, charge entry and credit, and CPT code verification to Lab Business Operations and Revenue Cycle teams.
• Communicate with reference labs to troubleshoot issues.
• Develop internal audits and quality controls in accordance with departmental policies, procedures, generally accepted accounting practices, and all applicable laws and regulations.
• Lead strategic review and standardization of laboratory billing processes and procedures; develop and maintain billing standard operating procedures.
• Review and reconcile referral lab invoices to verify pricing, patient billing accuracy, and approvals for timely payments.
• Serve as lead on CMS and commercial payer rules and regulations; proactively monitor, interpret, and communicate regulatory changes.
• Assist in creating and maintaining a routine audit process of the ChargeMaster, including changes, additions, and deletions, for laboratory testing charges and costs in close collaboration with Revenue Integrity.
• Maintain professional and technical competency in all aspects of laboratory billing and coding with respect to governmental and commercial payor practices and requirements.
• Participate in educational programs and learning opportunities.
• Perform miscellaneous job-related duties as requested.

Mission, Vision, & Values

Mission
To advance hope, healing and the best healthcare for children and their families.

Vision
Phoenix Children’s will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education. We realize this vision by:

• Offering the most comprehensive care across ages, communities and specialties
• Investing in innovative research, including emerging treatments, tools and technologies
• Advancing education and training to shape the next generation of clinical leaders
• Advocating for the health and well-being of children and families

Values
We place children and families at the center of all we do
We deliver exceptional care, every day and in every way
We collaborate with colleagues, partners and communities to amplify our impact
We set the standards of pediatric healthcare today, and innovate for the future
We are accountable for making the highest quality care accessible and affordable

Requirements

• Bachelor’s Degree in a relevant field or Associate’s Degree coupled with two years of billing compliance experience.
• Ability to work independently, handle multiple tasks, and exhibit problem-solving skills.
• High level of attention to detail, well-organized, and adept at effectively communicating with all levels of customers.
• Proven experience in Microsoft Office products including, at minimum, moderate competency with Excel skills.
• Comprehensive knowledge of CPT coding, HCPCS coding, modifiers, and government and commercial payor guidelines. Knowledge of professional fee billing, reimbursement, medical terminology, and HIPAA privacy laws.

Preferred Qualifications

• Advanced experience in laboratory coding, billing, and invoicing.
• Laboratory technical/technician experience.
• Revenue cycle payment collections skills and experience.
• Allscripts, SunQuest laboratory information system, and Image Express experience.
• Experience/knowledge with clinical laboratory and reference lab testing.
• Professional Coding Certification (CPC).

Physical Requirements

• Fine Motor Skills (pinching, gripping, etc) – Occasionally
• Hearing – Constantly
• Reaching – Occasionally
• Sitting – Constantly
• Standing – Occasionally
• Talking – Constantly
• Walking – Occasionally
• Near Vision – Constantly
• Use of keyboard, mouse and/or computer equipment – Constantly

Occupational Exposure/Risk Potential: Inside office environment