Cotiviti
5001 - 10000 employees
⚕️ Healthcare Insurance
💳 Fintech
🤖 Artificial Intelligence
Healthcare Insurance • Fintech • Artificial Intelligence
Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.
Lead Genetic Testing and Laboratory SME
🔥 0 minutes ago
🇺🇸 United States – Remote
💵 $110k - $140k / year
⏰ Full Time
🟠 Senior
🎣 Lead Generation
🦅 H1B Visa Sponsor
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Cotiviti
5001 - 10000 employees
⚕️ Healthcare Insurance
💳 Fintech
🤖 Artificial Intelligence
Healthcare Insurance • Fintech • Artificial Intelligence
Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.
📋 Description
• Provide deep expertise in molecular diagnostics (germline and somatic), next-generation sequencing (NGS) and multigene panels, and laboratory billing practices (CPT/HCPCS, PLA codes, stacking) • Act as the primary clinical partner to CST analysts to translate clinical intent into prepay-editable rule logic • Lead or co-lead development of Coding Validation (CV) edits, and postpay data-mining concepts across laboratory and genetic testing • Present rule logic and strategy to payer clients; translate complex genetic testing concepts into clear clinical narratives and financial impact/savings opportunity
🎯 Requirements
• Master’s degree in Genetic Counseling or related field • Board certification preferred (ABGC or equivalent) • 6-8+ years in genetic counseling, molecular diagnostics, and/or laboratory utilization management • Deep knowledge of CPT/HCPCS coding for lab/genetic testing, including NGS panel billing complexity and common billing patterns • Knowledge of prior authorization and utilization management frameworks as applied to genetic testing and laboratory services
🏖️ Benefits
• Health insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance coverage • 401(k) savings plans • Paid family leave • 9 paid holidays per year • 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti
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