Billing Coder Team Lead

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

Coding Team Leads are responsible for performing quality reviews and generating departmental reports on the performance of the department to ensure the department maintains high standards of quality and compliance. This position works in a computer-based billing software program and requires expert knowledge of all insurance types for all regions billed. Billing and coding subject matter expert (SME) supporting assigned Hematopathology and Anatomic Pathology billing and coding team

Key Job Elements

• Conducts information reviews and evaluates results comparing the requisition demographics and insurance information to the information that was entered into the billing system during the data entry process.
• Maintains QA at or above required 95% accuracy and performs additional training with individuals that fall below the standard to ensure the success of the team as a whole.
• Identifies and documents errors found in the data entry process using insurance guidelines and departmental procedures. Provides follow-up and training to individuals as needed.
• Reconciles NovoPath/Quadax file transmissions to ensure timely filing of cases.
• Maintains and reports department quality/productivity data monthly for the team.
• Downloads files from the billing system, imports data into Excel and creates worklists/assignments.
• Monitor denials for trends and evaluate processes that can be updated to ensure clean claims are sent out.
• Develop training documents and SOPs for department.
• Report to Senior Manager any deficiencies identified that affect TAT for case release to billing, denial trends, etc.
• Update LCD/NCD requirements as released by MCR each year. Provide education to the team regarding any changes that affect the coding department as a whole.
• Accepts other duties as assigned.

Knowledge/Experience

• Maintain current knowledge of Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-10) codes to ensure reliable communication with all physicians and coworkers and other healthcare providers and insurance carrier billing requirements.
• Proficient in 10 key and alpha/numeric data entry.
• Proficient in Microsoft Office Suite, specifically Word, Excel, Outlook, and general working knowledge of Internet for business use.
• Ability to work in a fast-past, deadline driven environment.
• Drive for Results (Service, Quality, and Continuous Improvement) – Ensure procedures and processes are in place that will lead to delivery of quality results and continually reassess their effectiveness to achieve continuous improvement.
• Communication – Proficient verbal and written communication skills. Ability to share and receive information and ideas from all levels of the organization in order to achieve the desired billing and coding results.
• Teamwork – Commitment to the successful achievement of team and organizational goals through a desire to participate with and help other members of the team.
• Customer Service Focus – Demonstrate a focus on clean claims to better serve the patients and clients.

Education, Certification/Licensure, and/or Experience

• High School diploma or equivalent required
• 13 years of medical coding experience OR 10 years of anatomic pathology coding experience.
• Certified Professional Coder Certification-CPC through AAPC or RHIT equivalent

Additional Skills

• Must possess ability to sit and/or stand for long periods of time.
• Must possess ability to perform repetitive motion.
• Ability to lift up to 15 pounds.
• The majority of work is performed in a desk/cubicle environment.

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.

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.