Billing Coder III

About Us

CSI Laboratories, a Fulgent Genetics Company, is a nationally recognized cancer testing and diagnostics laboratory experienced in helping pathologists and oncologists diagnose and treat cancer patients.

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

The Billing Coder III 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.
• Identify, research and resolve reimbursement matters related to coding and billing while working closely with Coding, Revenue Cycle Management and Medical Practice team.
• Communicates with insurance payors and management of all levels as needed to get maximum payment resolution on accounts.
• Analyzes coverage policies, payment rules, and coding changes affecting billing and collections.
• Analyze and review detailed and highly complex code edits and transactions within the billing system/LIS.
• Provide support to the billing staff by resolving complex cases and issues as assigned.
• Assist in new hire training and escalation points 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 meet 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 OR 7 years of anatomic pathology coding experience required.
• 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 the 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.

This job description reflects management's assignment of essential functions. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.