Pathology Coder

ROLES & RESPONSIBILTIES

• Review pathology accessions for MIPS-related coding requirements.

• Assign CPT, ICD-10, and appropriate modifiers based on documentation and QPP measure criteria.
• Collaborate with offshore coding teams to review impacted accessions and provide feedback.

• Validate MUE (Medically Unlikely Edits) logic and apply appropriate code substitutions (e.g., 88307 x x2).

• Identify and triage failed accessions for QA review and potential recoding or addendum

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• Ensure accurate classification of accessions as Pass, Fail, Exclude, or Exempt.

• Participate in monthly dashboard reviews and support CAP/MRO submission processes.

• Maintain compliance with CMS, CAP, and NHPMG coding standards.

• Support reconciliation of coded volumes and ensure reporting accuracy

QUALIFICATIONS:

• Graduate in Life Sciences (e.g., Nursing, Pharma, Biochemistry, Microbiology)
• Minimum 2 years of experience in pathology coding, preferably with MIPS/QPP exposure
• Strong understanding of CPT, ICD-10-CM, and modifier usage in pathology
• Familiarity with MUEs, QPP measures, and CMS coding guidelines

SKILLS & COMPETENCIES:

• In-depth knowledge of pathology terminology, procedures, and documentation

• Strong analytical and abstraction skills

• Experience working with coding platforms (e.g., XiFin, SFTP workflows)

• Excellent communication skills for collaboration with offshore teams and internal stakeholders
• Proficiency in Excel and reporting tools (preferred)

• Ability to work independently and manage timelines effectivel