Revenue Integrity Analyst - Laboratory

1046 Health Network Laboratories LLC; Honolulu (HI); Presencial; USD 70.000 - 100.000; Jornada completa

Descripción de la vacante

HNL Lab Medicine is seeking a CDM Specialist to lead charge capture and chargemaster maintenance in a fast-paced laboratory billing environment.

You will audit charges, ensure coding accuracy, and collaborate with laboratory, billing, and IT teams to support compliant, timely reimbursement. Knowledge of LIS, CPT/HCPCS, and pricing workflows is essential.

Formación

• High school diploma or GED; AS/BA in Health Information Management or related field.
• Experience in revenue cycle operations, chargemaster maintenance, medical billing, or CPT/HCPCS coding.
• 5+ years of experience as a medical technologist or equivalent in billing/compliance.

Responsabilidades

• Maintain and update the laboratory chargemaster (CDM), CPT/HCPCS, pricing, and rules.
• Audit charges, coding accuracy, and billing workflows for compliance and denial trends.
• Collaborate with lab leadership, billing, revenue cycle, finance, and IT on pricing and workflows.
• Develop CDM documentation and train staff on coding, billing, and charge capture requirements.
• Coordinate with partner hospitals for accurate invoicing and pricing reviews.

Conocimientos

Excel

Data analysis

Attention to detail

Analytical thinking

Educación

Associate's or Bachelor's degree in Health Information Management

Herramientas

LIS systems

Charge Master software

EHR integration

Descripción del empleo

Work Schedule: Monday-Friday 8:00a-4:30p

ESSENTIAL DUTIES AND RESPONSIBILITIES

• 1. Charge Capture & CDM Management Maintain and update the laboratory chargemaster (CDM), ensuring accurate CPT/HCPCS codes, revenue codes, modifiers, and pricing. Validate LIS test builds and charge mapping to ensure alignment with billing rules and reimbursement requirements. Monitor payer policy changes and implement necessary CDM or workflow updates.
• 2. Revenue Integrity & Compliance Conduct routine audits of laboratory charges, coding accuracy, and billing workflows to identify missing charges, errors, or compliance risks. Review denials and reimbursement trends to identify root causes and recommend corrective actions. Ensure compliance with federal and state regulations, including Medicare guidelines, NCCI edits, and medical-necessity requirements.
• 3. Cross-Functional Collaboration Partner with laboratory leadership, billing, revenue cycle, finance, and IT to support accurate charge capture and timely reimbursement. Support new test implementation by coordinating pricing, coding, and charge workflows. Participate in LIS/EHR upgrades, charge router updates, and system optimization projects.
• 4. Documentation, Reporting & Education Develop and maintain documentation for CDM processes, charge capture workflows, and regulatory updates. Prepare reports on charge accuracy, denial trends, and revenue integrity metrics. Provide training to laboratory and revenue cycle staff on coding, billing, and charge capture requirements.
• 5. External Partner Support Collaborate with partner hospitals and client institutions to ensure CDM alignment and accurate invoicing for laboratory services. Support contract pricing reviews and charge-related inquiries from external stakeholders.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience: High school diploma or general education degree (GED); Associate's or Bachelor's degree in Health Information Management, Business, Laboratory Science, or related field. Experience in revenue cycle operations, chargemaster maintenance, medical billing, or CPT/HCPCS coding; or 5+ years of experience as a medical technologist

Language Ability: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Convey a skilled phone manner for handling internal and external customers' issues. Working knowledge of clinical laboratory operations and terminology.

Math Ability: Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Reasoning Ability: Ability to work independently; demonstrate initiative and analytical ability; and possess excellent verbal and written communication skills. Possess strong attention to detail, and highly organized. Demonstrate the ability to work with minimal supervision and direction. Ability to work well in a fast-paced professional office and laboratory environment. Strong analytical skills and ability to interpret regulatory guidance.

Computer Skills: Capacity to cover a broad scope of technologies and functionalities. Proficiency with Excel and data analysis tools.

Certificates and Licenses: No certifications needed.

HNL Lab Medicine is an equal opportunity employer.

In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law.

All personnel actions and programs will adhere to this policy.

Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.

Address: 794 Roble Rd

Primary Location: HNL- Roble

Position Type: Onsite

Department: 1046-00015 Billing

We firmly believe that our employees drive the success of the organization. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and rewarding opportunities. Join us and discover a work experience where diverse ideas are met with enthusiasm, and where you can learn and grow to your full potential. We're looking for individuals who align with our Core Values and enjoy working as a team to create satisfying outcomes for our patients, customers and clients.

At HNL Lab Medicine, our patients are more than just test tubes. We understand the impact each test we analyze has on our patients' lives, and we never take that responsibility lightly.

Headquartered in Allentown, Pennsylvania, we provide testing and related services to physician offices, hospitals, long-term care facilities, employers, and industrial accounts. With more than 50 patient service centers throughout Pennsylvania, we provide accessible, patient-focused laboratory services in the communities we serve. Our team of more than 2,000 professionals includes 109 board-certified pathologists and scientific directors, along with more than 400 certified laboratory scientists and phlebotomists. Together, they bring deep expertise, operational excellence, accountability, and compassionate care to every test we perform.