Billing Coder III

DaMar Staffing; Town of Texas (WI); On-site; USD 65,000 - 90,000; Full time

Job summary

Inform Diagnostics, a Fulgent Genetics Company, is seeking a Billing Coder III to review documentation, assign CPT/ICD-10CM codes, and ensure accurate claims submissions across multi-specialty pathology services. You will work with the billing team, resolve complex denials, train new staff, and help maintain coding guidelines while meeting quality and production standards.

Candidates should have CPC, a high school diploma, and 7–10 years of pathology coding experience, plus proficiency with

Qualifications

• High school diploma or equivalent required.
• CPC certification (AAPC) required.
• 7–10 years of anatomic pathology coding experience or 10+ years of medical coding.
• Proficient CPT/ICD-10CM coding and familiarity with CPT, HCPCS and ICD conventions.
• Experience with Xifin/LIS and Microsoft Office Suite.

Responsibilities

• Research and assign CPT codes and ICD-10CM diagnoses based on review of the medical record.
• Analyze and review complex code edits and transactions within Xifin/LIS.
• Provide support to the billing staff by resolving complex cases and issues.
• Assist in new hire training and act as escalation point for teammates.
• Coding-related denials review and resolution.
• Contribute to development and maintenance of educational materials.
• Maintain knowledge of coding guidelines and regulations for audits.
• Meet department quality and production standards.
• Participate in testing and training of new system applications.

Skills

CPT coding

ICD coding

Communication skills

MS Office proficiency

Deadline driven

Education

High school diploma or equivalent

CPC certification (AAPC)

Tools

Xifin/LIS

Job description

Billing Coder IIIInform 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.

Each 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.
• Analyze and review detailed and highly complex code edits and transactions within Xifin/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.

QualificationsKnowledge/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 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 of the position. 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.