Billing Coder Team Lead - Anatomical Pathology

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