REGULATORY BILLING SPECIALIST

Precision Diagnostics, based in San Diego, California is a fast growing clinical laboratory that specializes in providing quantitative drug testing, primarily for the purpose of helping physicians monitor their patients undergoing treatment for pain or substance abuse. Precision’s objective is to improve patient adherence/compliance with their prescription regimen and protect medical practices from liability. 

Integrity & Quality are important to us in how we approach our business and you will be integral to both of these core principles.  This role is unique in that you will be bridging healthcare billing processes with legal & compliance so that we can continue to be positive contributors to our patients, providers & payer clients.  We take great pride in being proactive with billing and regulatory changes.  The perfect candidate will see themselves having fun solving complex problems in a cross-departmental environment while being results and performance driven. 

ESSENTIAL DUTIES: 

• Ensures compliance with federal, state and local legal requirements for reimbursement by researching existing and new legislation.  Advises management of actions and potential risks.
• Provide reporting and feedback to various departments for correct coding and billing of patient accounts.
• Completes internal coding reviews, audits, risk assessments and education (as applicable) for appropriate staff
• Knowledge of all payer types and related healthcare terminology.
• Work closely with the Billing and Compliance teams to ensure appropriate reimbursement and claim requirements and regulatory changes.
• Analysis of coding and billing trends.
• Implement programs to report billing practices concern.
• Maintains up-to-date knowledge of all payer, state, federal, and local changes.

EDUCATION/EXPERIENCE REQUIREMENTS:

• BA/BS preferred, or equivalent work experience
• Skilled in research and knowledge of Medicare billing policies including modifiers, NCD and LCD and Medicaid regulations.
• Ability to interpret, adapt, and apply CMS guidelines and procedures.
• Knowledge of CPT coding, ICD-9 and ICD-10
• Compliance, Law & Ethics (HIPAA)
• Previous experience working with laboratory billing
• AAPC Certified Professional Coder and/or AHIMA Certified Coder certification