Description
Job Title: Billing & Compliance Analyst
Department: Laboratory - Administration
Location: Rochester General Hospital | 1425 Portland Ave. Rochester, NY 14621
Hours Per Week: 40
Schedule: Monday - Friday, 8-hour shifts, 8:00a - 4:30p
SUMMARY
Assists in implementing strategies to improve services and operating methods related to laboratory charge capture, coding, billing & compliance. The role of the Billing & Compliance Analyst will be to assist in ensuring accurate and timely billing information for reimbursement for services rendered. Ability to effectively and efficiently utilize system resources to resolve issues and prepare reports is required.
RESPONSIBILITIES:
- Collaborates with healthcare professionals as applicable to discuss findings and offer advice and education as to how to improve denial rates.
- Works with CBO and HIM to identify billing adjustments and denial issues.
- Conducts annual billing code reviews, interfaces with coding and charge capture teams.
- Develops billing reports to identify charging or coding issues, and reports findings to office manager.
- Performs tasks such as pivot table creation and data mining.
- Participates in appropriate committees.
- Coordinates and conducts billing audits and special projects. Projects may include research into billing issues, system issues, or third-party payer issues affecting billing compliance and reimbursement.
- Plans and carries through to completion proactive studies to assess billing quality.
- Interacts with laboratory departments to discuss billing compliance issues and uses the information for recommending change of existing procedures or processes as directed by the manager.
- Develop and update department policies as needed.
- Keep current with CMS national and local coverage policies and other CMS regulations.
- Coordinates training of lab registrars on billing and registration processes which directly affect reimbursement, as requested.
- Responsible for review, analysis, recommendations and defining implementation time frames for process improvements. Serve as project leader for related process improvement teams.
- Assists coding with NCCI and MUE issues.
- Authors help star tickets to correct system errors found by observing trends on various WQs.
- Work with CareConnect IT team to resolve identified issues with claims and other software related concerns, including testing of changes/updates made to billing applications.
- Facilitate a billing process that performs all functions of the professional and technical revenue billing cycle to ensure cash flow within established goals.
- Ensure that all systems are operating in accordance with departmental and regulatory compliance.
- Identify trends and recurring issues for HB and PB billing management teams' productivity, training and education.
- Performs routine account review of open billing invoices. Based on findings, provides feedback to Supervisors of Business Office personnel on quality and productivity of work, one-on-one training with individual Business Office Associates to address issues, and conducts group training sessions as needed on identified major issues. Produces documentation when corrective actions are needed.
- Monitors and identifies progress and/or potential problems in the revenue cycle process and accounts receivable, assisting with the development and implementation of solutions.
- Prepares status reports/presentations for RGHS Executive Leadership Team and Finance Committee. Develops and reports on key Accounts Receivable metrics on a weekly and monthly basis.
- Represents business office in the process of software implementations or process changes/updates, participating in testing of billing software applications, ensuring the integrity if financial interests of the revenue cycle.
- Knowledge of all aspects of SoftLab Lab Information System pertaining to AR. Includes running billing files, setting up new tests and insurances. Works closely with Laboratory Information System team on all system upgrades. Implements, tests and validates billing flow for each test.
- Proficiency with database and required hot fixes of database files and validations. Responsible for ensuring billing files work correctly.
- Maintain Laboratory Chargemaster, ensuring CareConnect billing requirements are met for each test that is added to the system.
REQUIRED QUALIFICATIONS:
- Previous billing and third-party payor experience required
- Minimum of 4 years related work experience in billing and/or patient access, working with CPT codes
PREFERRED QUALIFICATIONS:
- Associate's degree preferred
- Experience with Epic, SoftAR/SCC, LIS applications, healthcare billing, coding, revenue cycle, or charge master management
- Knowledge of CPT, HCPCS, Medicare, Medicaid, and commercial payer billing requirements
- Strong analytical and problem-solving skills
- Experience working across multiple departments, including laboratory operations, finance, IT, and revenue cycle
- Advanced Excel and data analysis skills
- Ability to manage multiple priorities independently and investigate complex billing, charging, and interface issues
PHYSICAL REQUIREMENTS: Sedentary - Sedentary roles are primarily office-based and require prolonged sitting (67–100% of the workday) with minimal physical effort and lifting limited to under 10 lbs. Fine motor skills are necessary for computer work, writing, and telephone use, supported by clear visual and auditory ability. Cognitive and emotional demands are high due to extended concentration, frequent interruptions, independent decision-making, and information processing. Although physical exposure is low, administrative areas within healthcare environments may occasionally involve contact with infectious agents. Some roles may require flexible hours, TB screening, or a valid driver’s license.
PAY RANGE: $23.50 - $29.00
The listed base pay range is a good faith representation of current potential base pay for successful applicants. It may be modified in the future. Pay is determined by factors including experience, clinical licensure date, relevant qualifications, specialty, internal equity, location, and contracts.
