Job Summary for Medical Coder Diagnostic Laboratory

- Assign accurate CPT/HCPCS codes, units, and modifiers for a broad range of laboratory services (toxicology/UDT, molecular/PCR, pathology, routine lab).
- Independently validate coding decisions against test performed, provider order, payer requirements, and Medicare policies.
- Efficiently use encoder/computer-assisted coding software; review and override software recommendations as necessary.
- Code complex laboratory scenarios such as unmapped tests, reflex testing, add-ons, current/revised codes, and multi-code panels.
- Ensure coding output aligns with claim submission and reimbursement requirements.
- Apply coding knowledge specifically for toxicology/UDT, understanding presumptive vs. definitive testing, frequency/units, and medical necessity.
- Accurately code molecular/PCR panels, manage multi-target and repeated units, and prevent payer denials.
- Assign pathology CPT codes based on documentation for surgical pathology, special stains, and IHC; clarify missing/inconsistent records.
- Code routine laboratory tests (chemistry, hematology, immunology, organ panels, TDM) with correct CPT/HCPCS and ICD-10-CM codes.
- Research and apply Medicare, Medicaid, and commercial payer policies (LCDs, NCDs,



billing articles, coverage edits) to claims.
- Monitor and implement policy and coding updates; maintain policy-referenced diagnosis-to-test crosswalks.
- Understand SNF (skilled nursing facility) and Medicare Part A/B laboratory billing rules, including consolidated billing and place of service codes.
- Analyze coding-related denials, determine root cause, and recommend process improvements to minimize recurring errors.
- Communicate findings and risks to billing and operations teams; escalate compliance/audit concerns as needed.
- Demonstrate strong technical knowledge of laboratory CPT/HCPCS/ICD-10-CM code ranges and collection/travel codes.
- Interpret EOBs, ERAs, and 835 remittance files to understand payment/denial reasons.
- Work independently, accurately, and efficiently in a high-volume U.S. clinical laboratory coding environment.
- Maintain strict attention to detail, coding accuracy, and compliance with all payer requirements.
- Preferred: Hold AAPC/AHIMA certification (CPC, CPB, CCS); possess experience with LCDs/NCDs, NGS policies, coding audits, denial prevention, and advanced Excel for data analysis.

📌 Medical Coder – Diagnostic Laboratory (India)
🏢 Staffingly
📍 India