UnityPoint Health - St. Luke's
10am - 6:30pm
Interfaces the laboratory to its Reference Laboratory and Hospital Customers by performing complex reference laboratory patient registrations as well as registrations for hospital laboratory outpatients, in both the Hospital Information System as well as in the Laboratory Information System. Determines Reference Laboratory billing based on numerous location codes for each facility. Orders all testing for the hospital laboratory in the Laboratory Information System, receives electronic orders and completes appropriately, and determines and validates medical necessity of all lab orders in addition to obtaining appropriate diagnoses from providers. Verifies the integrity of Reference Lab outreach shipments, performs specimen processing and communicates with Outreach Reference Clients and various hospital departments. Communicates specimen deliveries with laboratory couriers, communicates and distributes test results to providers, clients, and patients, performs manual charge entry and performs support functions for the pathologists, including medical examiner requests.
Clinical Excellence/Patient Care
- Provides specimen processing for reference laboratory outreach patient testing, and initiates inpatient processing, requiring handling of patient specimens.
- Assists lab outpatients in the collection process of specimens for testing.
- Monitors patients during more complex lab test procedures and patients being held for provider notification of test results.
- Collection of money from walk-in lab outpatients for lab testing and receipt completion.
- Uses the Lab and Mayo On-line test catalogs to ensure that the correct tests are ordered for providers and patients.
- Participates and provides feedback in the implementation of quality processes with a focus on Lean Methodology and other quality improvement resources. Participates in lab regulatory CAP, CLIA, and DNV surveys.
- Assists patients in the completion of Authorizations prior to release of test information.
- Initiates and resolves the problem patient specimen resolution process for the laboratory.
- Communicates and interacts with patients and their families, with compassion and empathy, both on the phone and at the lab department.
- Informs patients of potential denial by insurance, estimates appropriate costs and obtains appropriate ABN or Insurance Waiver according to insurance. Adds modifiers and account notes as appropriate per regulations.
Technical and Operational Expertise
- Performs complex reference laboratory patient registrations as well as registrations for hospital laboratory outpatients, in both the Hospital Information System as well as in the Laboratory Information System, with a high degree of focus and minimal registration errors.
- Investigates and confirms insurance eligibility with minimal information available by phone or computer to prevent error and delay of payment.
- Registration, test ordering, and processing outside facility pre-specimen collections to include lab test label generation.
- Obtains, investigates, and verifies both written and add on orders from physicians and other care providers, both for reference lab clients and lab outpatients. Scans all order documentation, etc. into the appropriate patient’s medical record.
- Obtains diagnoses for lab testing performed, and determines appropriate medical necessity and coding documentation in compliance with CMS and Health System Guidelines. Researches National and Local Coverage Determinations to assist with diagnosis and medical necessity with lab clients.
- Investigation of denials, to include insurance and medical necessity issues for resolution.
- Thorough knowledge and understanding of lab test order codes in the Lab Information System. Receives and completes electronic interfaced test orders from lab clients appropriately.
- Determination and entry of numerous different location codes into the Hospital Information System, as well as the Laboratory Information System, dependent on reference facility to facilitate test results interfacing to the correct client and facility. Determines whether reference client billing or insurance billing is required dependent on pre-set client and insurance requirements. Interface number entry requirement dependent on type of lab interface with each client.
- Specimen processing to include verification of the integrity of specimen shipments through patient identification processes and specimen receipt verification. Handles and distributes specimens to work areas by manual delivery to lab hospital departments. Handling and separating specimens with specific knowledge of which tests are performed in each lab department.
- Performs various lab business office functions within regulatory guidelines that include but are not limited to registration operations, insurance verification, confidential fax verifications, and other functions as required.
Basic UPH Performance Criteria
- Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.
- Demonstrates ability to meet business needs of department with regular, reliable attendance.
- Employee maintains current licenses and/or certifications required for the position.
- Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.
- High School Diploma or equivalency
- 1 year work experience. Proficiency with computer data entry functions.
- Experience in lab registration, order entry and specimen processing as well as experience with medical necessity requirements preferred.
- Valid driver’s license when driving any vehicle for work-related reasons.
- Writes, reads, comprehends and speaks fluent English.
- Multicultural sensitivity.
- Microsoft Office – basic computer skills.
- Customer/patient focused.
- Critical thinking skills using independent judgment in making decisions.