Diagnostics Revenue Cycle Specialist

Diagnostics Revenue Cycle Specialist

Responsibilities

Oversee end-to-end revenue cycle processes for diagnostic services, including charge capture, coding, billing, and collections

Verify patient insurance eligibility and benefits for diagnostic procedures

Review and validate diagnostic test orders, documentation, and medical necessity requirements

Maintain accurate patient billing records

Ensure accurate coding using CPT, ICD-10, and HCPCS systems

Prepare claims for submission to insurance carriers and follow up on unpaid or denied claims

Analyze and resolve claim rejections, denials, and underpayments

Monitor aging reports and prioritize collection efforts

Ensure compliance with federal and state regulations, including HIPAA and payer-specific guidelines

Collaborate with management to improve documentation and billing accuracy

Identify trends in denials and recommend process improvements

Requirements

High school diploma or equivalent

2+ years of experience in medical billing, preferably in diagnostics (lab, radiology, or pathology)

Strong knowledge of LCDs, NCDs, Payor Policies, CPT, ICD-10, and HCPCS coding systems

Experience with insurance large customer base and high transaction volume of claims, EOBs, and reimbursement processes

Familiarity with EHR and billing systems

Excellent analytical, organizational, and problem-solving skills

Strong attention to detail and accuracy

Proficiency with Microsoft Office Suite

Ability to prioritize and manage time appropriately

We are an Equal Opportunity Employer and committed to providing reasonable accommodations to individuals with disabilities. If you require accommodations during the application or interview process, please contact [email protected].