Pre Billing Specialist I

Pre-Billing Specialist IThe Pre-Billing Specialist I is responsible for supporting the laboratory revenue cycle by ensuring accurate and complete claim preparation prior to submission. This role focuses on reviewing, validating, and correcting patient, insurance, and test order information to produce clean claims and minimize denials. The ideal candidate is detail-oriented, organized, and able to work within established workflows to meet productivity and quality standards.*Please note this is an in-person position.

Candidates are expected to be on-site for all worked hours.Key ResponsibilitiesPre-Billing & Claim PreparationReview laboratory orders and associated documentation for completeness and accuracy prior to billingValidate patient demographics, insurance information, and provider detailsIdentify and correct errors that may prevent successful claim submissionData Verification & Quality ControlEnsure all required elements for claim submission are present, including diagnosis codes and test codesApply basic medical necessity guidelines and flag discrepanciesWork assigned pre-bill edits and queues within billing systemsCharge & Coding SupportAssist with charge entry validation to confirm alignment between performed tests and billable servicesVerify correct CPT/HCPCS codes are applied based on established guidelinesEscalate complex coding or medical necessity issues to senior team membersWorkflow & System UseUtilize laboratory information systems (LIS), billing systems, and clearinghouse toolsMaintain productivity standards for volume and turnaround timeFollow standardized workflows and payer-specific requirementsCollaboration & Issue ResolutionPartner with accessioning, coding, and billing teams to resolve discrepanciesCommunicate clearly regarding missing or conflicting informationSupport denial prevention efforts through proactive issue identificationRequired QualificationsHigh school diploma or equivalentAt least 1 year of experience in healthcare, medical billing, or data entry (lab experience preferred but not required)Strong attention to detail and accuracyBasic computer and data entry skillsAbility to follow structured workflows and meet deadlinesPreferred QualificationsExposure to medical billing, revenue cycle, or laboratory operationsFamiliarity with CPT/HCPCS codes, ICD-10 diagnosis codes, or medical terminologyExperience working with EMR, LIS, or billing systemsCore CompetenciesDetail orientation and accuracyTime management and productivityCritical thinking and problem-solvingCommunication and teamworkAdaptability in a fast-paced, high-volume environment