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Indiana University Health

Pathology and Lab Medicine Pre-Billing Program Manager

IU Health Physicians Support Services
Date Posted
21 February, 2024
Schedule & Shift
Full Time
Day
Requisition Number
360843
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Pathology and Lab Medicine Pre-Billing Program Manager

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Job Description

Overview

Come join the Department of Pathology and Laboratory Medicine!  We are in need of a Program Manager to oversee the pre-RCS billing process for both professional and technical charges.  This individual will have to learn and understand the complexities to pathology and lab medicine billing as it relates to front-end operations including LIS systems.  We look forward to finding someone who is up to the challenge of navigating our highly matrixed organization to put all the pieces together.

The Department of Pathology and Laboratory Medicine is comprised of complex, high volume, and highly regulated testing activities that translate into an equally complex billing process.  This position is managing the billing process integrity from the various pathology and laboratory medicine system EMR’s (sources of transactional truth) until the point that files are delivered to revenue cycle services (RCS).  This position is tasked with ensuring pathology and laboratory pre-billing operations are compliant and complete. Working with LIS (laboratory information services), revenue cycle services, and operational stakeholders, this position focuses on billing optimization.  This position will focus on establishing documentation, workflow mapping, and appropriate procedures for all billing transactions, both technical and professional in nature.  The position will be fully supported while they develop laboratory specific knowledge with the expectation of becoming well versed in billing rules for pathology and laboratory medicine.  As part of the mentoring process this position will attend national conferences to learn and bring back pathology and laboratory medicine billing expertise to the health system.  The position will serve as a consultant and liaison to revenue cycle services when field specific questions arise.  Duties may include but are not limited to: 

  • Creating complete billing workflows both professional and technical charges
    • Laboratory billing operations
      • Outreach testing
      • Send-out testing
      • Research and clinical trials
    • Pathology billing operations
      • Professional interpretations
      • Professional outreach
      • Professional component of clinical pathology
      • Research and clinical trials
      • Professional consult services
      • Professional agreement work (Eskenazi, VA, and Marion County Coroner’s office)
  • Creating an automated reconciliation process to audit through the system
    • Using the Copath EMR as a source of truth, track cases from the arrival of the patient sample, through accessioning, through the professional interpretation, and finally through the RCS billing process to analyze processed claims data against the system source of truth.
    • Using Cerner as a source of truth, track tests through the system and reconcile against processed claims data from RCS. 
    • Document discrepancies and create project workflows for issues that are found so they can be resolved.

 

  • Use results of reconciliation data to enhance billing operations. 
  • Maintain professional fee schedule requests as new CPT codes and tests are added to the menu (weekly occurrence).
  • Oversee the transition of the IUHP professional component of clinical pathology billing process to in-house scripts and processes that are owned by LIS.
  • Participate in the process to register laboratory developed tests and molecular tests (MolDX)
  • Sits on all RCS “Pathways to Improvement” workgroups for both the lab and for pathology. 
  • Liaises with operations to improve data collection and processes to support clean billing processes. 

 

This position will be building the billing optimization operation from scratch so the ability to step in navigate uncharted waters is required. The ideal candidate will have experience with billing processes and billing analysis.  The ability to write queries using SQL is highly desirable given the size and complexity of the data.  Experience mining data from enterprise data warehouses or other databases is highly desirable.  Experience working in highly matrixed reporting structures is required as this position will require working across three organizations and many departments and divisions.  Succinct communication skills and the ability to summarize complex ideas and theory are required.  The ideal candidate will be comfortable in an environment where they do not have all the answers and will constantly be learning

 Bachelor's Degree is required.
• Requires 5-7 years of relevant and complex project management experience.
• Program management experience is preferred.
• Healthcare industry experience is a plus.
• Requires experience working in a complex, matrix environment.

 

We are an equal opportunity employer and value diversity and inclusion at IU Health. IU Health does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.

Qualifications for the Pathology and Lab Medicine Pre-Billing Program Manager Role

Overview

Come join the Department of Pathology and Laboratory Medicine!  We are in need of a Program Manager to oversee the pre-RCS billing process for both professional and technical charges.  This individual will have to learn and understand the complexities to pathology and lab medicine billing as it relates to front-end operations including LIS systems.  We look forward to finding someone who is up to the challenge of navigating our highly matrixed organization to put all the pieces together.

The Department of Pathology and Laboratory Medicine is comprised of complex, high volume, and highly regulated testing activities that translate into an equally complex billing process.  This position is managing the billing process integrity from the various pathology and laboratory medicine system EMR’s (sources of transactional truth) until the point that files are delivered to revenue cycle services (RCS).  This position is tasked with ensuring pathology and laboratory pre-billing operations are compliant and complete. Working with LIS (laboratory information services), revenue cycle services, and operational stakeholders, this position focuses on billing optimization.  This position will focus on establishing documentation, workflow mapping, and appropriate procedures for all billing transactions, both technical and professional in nature.  The position will be fully supported while they develop laboratory specific knowledge with the expectation of becoming well versed in billing rules for pathology and laboratory medicine.  As part of the mentoring process this position will attend national conferences to learn and bring back pathology and laboratory medicine billing expertise to the health system.  The position will serve as a consultant and liaison to revenue cycle services when field specific questions arise.  Duties may include but are not limited to: 

  • Creating complete billing workflows both professional and technical charges
    • Laboratory billing operations
      • Outreach testing
      • Send-out testing
      • Research and clinical trials
    • Pathology billing operations
      • Professional interpretations
      • Professional outreach
      • Professional component of clinical pathology
      • Research and clinical trials
      • Professional consult services
      • Professional agreement work (Eskenazi, VA, and Marion County Coroner’s office)
  • Creating an automated reconciliation process to audit through the system
    • Using the Copath EMR as a source of truth, track cases from the arrival of the patient sample, through accessioning, through the professional interpretation, and finally through the RCS billing process to analyze processed claims data against the system source of truth.
    • Using Cerner as a source of truth, track tests through the system and reconcile against processed claims data from RCS. 
    • Document discrepancies and create project workflows for issues that are found so they can be resolved.

 

  • Use results of reconciliation data to enhance billing operations. 
  • Maintain professional fee schedule requests as new CPT codes and tests are added to the menu (weekly occurrence).
  • Oversee the transition of the IUHP professional component of clinical pathology billing process to in-house scripts and processes that are owned by LIS.
  • Participate in the process to register laboratory developed tests and molecular tests (MolDX)
  • Sits on all RCS “Pathways to Improvement” workgroups for both the lab and for pathology. 
  • Liaises with operations to improve data collection and processes to support clean billing processes. 

 

This position will be building the billing optimization operation from scratch so the ability to step in navigate uncharted waters is required. The ideal candidate will have experience with billing processes and billing analysis.  The ability to write queries using SQL is highly desirable given the size and complexity of the data.  Experience mining data from enterprise data warehouses or other databases is highly desirable.  Experience working in highly matrixed reporting structures is required as this position will require working across three organizations and many departments and divisions.  Succinct communication skills and the ability to summarize complex ideas and theory are required.  The ideal candidate will be comfortable in an environment where they do not have all the answers and will constantly be learning

  • qualifications__list
     Bachelor's Degree is required.
  • Requires 5-7 years of relevant and complex project management experience.
  •  Program management experience is preferred.
  •  Healthcare industry experience is a plus.
  •  Requires experience working in a complex, matrix environment.

Job Page Content image

Indiana University Health is Indiana’s most comprehensive health system, with 16 hospitals and nearly 40,000 team members serving Hoosiers across the state. Our partnership with the Indiana University School of Medicine gives our team members access to the very latest science and the very best training, advancing care for all. We’re looking for team members who share the things that matter most to us. People who are inspired by challenging and meaningful work for the good of every patient. People who are compassionate and serve with a purpose. People who aspire to excellence every day. People who are always ready to apply themselves.

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