Billing & Denials Specialist – Lab Claims Expert

Simple Laboratories; Harwood Heights (IL); On-site; USD 52,000 - 68,000; Full time

Benefits offered by this job

401(k)

401(k) Matching

Paid Time Off (PTO)

Health Insurance

Vision Insurance

STD/LTD

Hospital Indemnity Insurance

Critical Illness insurance

Job summary

Simple Laboratories in Harwood Heights, IL seeks a Billing and Denial Claims Specialist to join the Revenue Cycle Management team. The on-site role focuses on identifying, analyzing, preventing, and resolving insurance claim denials to maximize reimbursement and minimize delays.

The ideal candidate has strong knowledge of lab billing, payer policies, coding, and denial/appeal processes, with experience in Medicare/Medicaid and laboratory-specific requirements. On-site hours are 9:00 AM–5:30 PM.

Qualifications

• 3+ years of experience in medical billing, claims follow-up, denial management, or revenue cycle management.
• Working knowledge of healthcare claims and payer reimbursement processes.
• Strong attention to detail and ability to analyze complex claim information.
• Excellent written and verbal communication skills.
• Ability to manage multiple accounts, deadlines, and payer requirements independently.
• Proficiency with Microsoft Office and healthcare billing or practice-management systems.

Responsibilities

• Monitor and manage denied, rejected, and underpaid laboratory claims from initial identification through resolution.
• Research denial reasons and determine root causes, including eligibility, authorization, medical necessity, coding, modifier, bundling, documentation, timely filing, and payer-specific issues.
• Review laboratory claims for appropriate CPT/HCPCS codes, ICD-10-CM diagnosis codes, modifiers, units, ordering-provider information, and other billing requirements.
• Investigate payer policies and determine appropriate corrective action, rebilling, reconsideration, or formal appeal.
• Prepare and submit accurate first-level and subsequent-level appeals, including supporting documentation and medical records when appropriate.
• Track appeal deadlines, payer responses, outstanding balances, and expected reimbursement.
• Communicate with payers regarding claim status, denials, payment discrepancies, and appeal determinations.
• Identify recurring denial trends and recommend corrective actions to prevent future denials.
• Review payer-specific requirements related to laboratory testing, medical necessity, prior authorization, coverage policies, and documentation.
• Maintain accurate denial and appeal records and document all follow-up activities in the billing or practice-management system.
• Escalate complex or high-dollar claims, payer disputes, compliance concerns, and potential contractual issues to management.
• Assist with payer audits, reimbursement reviews, and revenue-cycle performance initiatives.
• Meet established productivity, quality, appeal turnaround, and recovery targets.
• Maintain confidentiality of patient and laboratory information in accordance with HIPAA and applicable organizational policies.

Skills

Medical billing experience

Denial management

Payer reimbursement knowledge

Attention to detail

Communication skills

Independent work

Education

High school diploma or equivalent

CPC/CCS certification (preferred)

Tools

Microsoft Office

Billing software

Clearinghouses

Job description

Simple Laboratories in Harwood Heights, IL seeks a Billing and Denial Claims Specialist to join the Revenue Cycle Management team. The on-site role focuses on identifying, analyzing, preventing, and resolving insurance claim denials to maximize reimbursement and minimize delays.

The ideal candidate has strong knowledge of lab billing, payer policies, coding, and denial/appeal processes, with experience in Medicare/Medicaid and laboratory-specific requirements. On-site hours are 9:00 AM–5:30 PM.