Billing Coder III - Molecular

About Us

Inform Diagnostics, a Fulgent Genetics Company, is a nationally recognized diagnostics laboratory focused on anatomic pathology subspecialties including gastrointestinal pathology, dermatopathology, urologic pathology, hematopathology, and breast pathology.

Founded in 2011, our parent entity, Fulgent Genetics, has evolved into a premier, full-service genomic testing company built around a foundational technology platform.

Through our diverse testing menu, Fulgent is focused on transforming patient care in oncology, anatomic pathology, infectious and rare diseases, and reproductive health. We believe that by providing a wide range of effective, flexible testing options in conjunction with best-in-class service and support, we can redefine the way medicine is managed for patients and clinicians alike.

Since integrating with our therapeutic development business, Fulgent is also developing drug candidates for treating a broad range of cancers using a novel nanoencapsulation and targeted therapy platform. By merging our fields of expertise, we aim to become a fully integrated precision medicine company.

Summary of Position

Each Billing Coder III - Molecular is responsible for documentation review, coding, and data abstracting of medical service documentation to ensure the company receives appropriate reimbursement and conforms to applicable guidelines and regulations. Patients and their needs are our primary focus, so developing and sustaining productive member relationships is key to success.

Key Job Elements

• Research and assign pathology procedures (CPT) and diagnosis (ICD-10CM) codes based on review of the entire medical record.
• Analyze and review detailed and highly complex code edits and transactions within Quadax/LIS.
• Provide support to the billing staff by resolving complex cases and issues as assigned.
• Assist in new hire training and escalation point for teammates.
• Coding related denials review for resolution.
• Contribute to the development and maintenance of specialized educational materials.
• Maintain current knowledge of coding conventions, guidelines, and regulations governing government and third-party billing to ensure that coding and documentation meets regulatory guidelines and audit standards.
• Meet department quality and production standards.
• Participate in the testing and training of new system applications.

Knowledge/Experience

• High School diploma or equivalent required.
• 10 years of medical coding experience and 5 years of NGS coding experience required.

Molecular

• Knowledge of NGS (Next Generation Sequencing) reimbursement by NGS Medicare, specific to include met for both the patient and the diagnostic test, including the patient's cancer diagnosis and stage.
• Current Procedural Terminology (CPT) codes, like the NGS-specific codes 81445 and 81455, or other codes such as Tier 1 (81105-81364), Tier 2 (81400-81408), and unlisted codes (81479), to bill for Next Generation Sequencing (NGS) testing.
• Knowledge of Proprietary Laboratory Analyses (PLA) codes: Test-specific codes for unique lab-developed tests. Multi-Analyte with Algorithmic Analyses (MAAA): Codes for tests using an algorithm to analyze multiple results. Genomic Sequencing Procedures (GSP) codes: Codes for simultaneously assaying multiple genes or regions

General/AP

• Ability to proficiently use Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-10) codes to ensure reliable communication with all physicians, insurance companies, and other healthcare providers.
• Working knowledge of CPT, HCPCS and ICD.
• Certified Professional Coder Certification - CPC through AAPC
• Demonstrated ability to abstract and assign all codes to multi-specialty pathology services performed, including, but not limited to Hematopathology.
• Knowledge of Local Coverage Determination and National Coverage Determination (LCD/NCD).
• Extensive knowledge of resolving coding related denials caused by MUE Edits, CPT codes, ICD codes, modifiers or medical necessity requirements.
• Ability to work in a fast-paced, deadline driven environment.
• Excellent written and oral communication.
• Proficient in Microsoft Office Suite, specifically Word, Excel, and Outlook, and general working knowledge of Internet for business use

Environment

Fulgent Therapeutics LLC is an Equal Employment Opportunity Employer.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. The term “qualified individual with a disability” means an individual with a disability who, with or without reasonable accommodation, can perform the essential functions of the position.

Please note that Fulgent (and its affiliated companies, including Inform Diagnostics and CSI Laboratories) does not accept unsolicited information and/or resumes from search firms or agencies for our job postings. Search firms or agencies without an applicable contract and/or express approval to recruit for the role in question — that choose to submit a resume or client information to our career page or to any employee of Fulgent — will not be eligible for payment of any fee(s), and any associated shared data will become the property of Fulgent.