Pre Billing Specialist I

Key Responsibilities

• 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

• 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