Pre-Billing & Claims Specialist Physicians Group Laboratories | Houma, LA | On-Site | Full-Time | Non-Exempt (Hourly)
ABOUT PGLPhysicians Group Laboratories (PGL) is a CAP-accredited diagnostic laboratory committed to delivering accurate, reliable testing to the providers and patients we serve. Behind every test is a revenue cycle process that ensures our services are billed accurately, supported by appropriate documentation, and compliant with payer and regulatory requirements. THE ROLEAs a key member of our Revenue Cycle team, you serve as the final checkpoint before a claim is submitted to a payer. Every claim you release represents our assurance that the testing was properly ordered, performed, coded, documented, and billed. You will review charges against orders and supporting documentation, identify and resolve discrepancies before they result in denials, and hold claims that require correction or additional information. This role requires strong attention to detail, sound judgment, and a commitment to getting it right the first time. WHAT YOU WILL DO Charge Review & Claim Preparation Review charges from the laboratory information system against the test requisition: patient demographics, insurance, ordering provider and NPI, date of service, tests ordered, and diagnosis codes Confirm that CPT/HCPCS codes match the tests actually ordered and performed, and that ICD-10 diagnosis codes come from the ordering provider Verify insurance eligibility and coverage, and that any required prior authorization or Advance Beneficiary Notice (ABN) is on file Check for duplicate charges, NCCI/MUE edits, and payer-specific billing rules before submission
Claim Submission & Rejections Submit clean claims through CollaborateMD within established timelines to protect timely-filing windows Work clearinghouse and payer front-end rejections daily, correct data and formatting errors, and resubmit Maintain productivity standards while keeping first-pass accuracy at the expected level
Holds, Escalation & Prevention Place claims with missing or unclear information on hold, and work with client services and accessioning to get correct documentation from the ordering provider Track the most common pre-billing errors by source (client, accessioning, interface, payer setup) and share trends with leadership so they can be fixed upstream Partner with the A/R team to close the loop on denials that started as front-end errors
Compliance & Documentation Bill only what is ordered, performed, and supported. Never add, change, or assume diagnosis codes, and never bill a test without a valid order Document holds, corrections, and the reason behind each in the billing system so the account history is audit-ready Raise any billing practice that appears improper with the Compliance Officer or through PGL’s compliance reporting channel. Good-faith reports are protected from retaliation Protect patient health information in accordance with HIPAA
WHAT SUCCESS LOOKS LIKE First 30 days: Trained on CollaborateMD, PGL’s test menu, payer requirements, and our hold-and-escalation process, and reviewing claims with a second check By 60 days: Independently processing a full daily claim volume and working rejections without carryover By 90 days: Meeting clean-claim and timeliness targets, and bringing forward at least one recurring front-end error with a recommended fix
How performance is measured Clean-claim rate (claims accepted on first submission) Days from date of service to claim submission Clearinghouse and payer rejection rate Front-end denials traced back to pre-billing Claims processed per day, and accuracy on periodic audit review
WHAT YOU BRING 1+ year of medical billing, claims processing, or charge entry experience Working knowledge of CPT, ICD-10, and HCPCS coding, and of commercial and government payer requirements Experience with a practice management or billing system and a claims clearinghouse Strong attention to detail, and the judgment to stop a claim that is not right rather than push it through High school diploma or equivalent
Preferred Clinical laboratory billing experience (pathology and laboratory CPT codes, panels, molecular, and toxicology testing) Experience with CollaborateMD Familiarity with Medicare medical necessity rules (NCDs/LCDs), ABNs, and NCCI edits Coding or billing certification such as CPC, CPB, or CRCR
WHY JOIN PGL You protect the business. Clean claims mean faster payment, fewer denials, and less rework for everyone downstream You get real training. We will train you on CollaborateMD, laboratory billing, and the payer rules that make this specialty different Integrity comes first. We would rather hold a claim than send it wrong, and we back the people who raise concerns Benefits: Medical, dental, vision, PTO, paid holidays, 401(k) with match
SCHEDULE & LOCATION On-site at the Physicians Group Laboratories Houma, LA location. This is not a remote or hybrid position Monday–Friday, 8:00 a.m.–4:30 p.m.
PHYSICAL REQUIREMENTS & WORK ENVIRONMENT Office environment. Requires prolonged sitting and extended computer and phone use. Occasionally lifts up to 15 lbs. Reasonable accommodations are available to enable individuals with disabilities to perform the essential functions of the role. PGL is an equal opportunity employer. We consider all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, genetic information, or any other characteristic protected by law
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