Clinical Billing Integrity Lead Analyst

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $100k - $120k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

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GeneDx

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🧬 Biotechnology

🏥 Healthcare

🤖 Artificial Intelligence

Biotechnology • Healthcare • Artificial Intelligence

GeneDx is a biotechnology company dedicated to providing personalized and targeted medical care through genetic diagnosis. Leveraging one of the largest datasets for rare diseases, GeneDx offers advanced testing such as whole genome and exome sequencing. Their diagnostic solutions translate complex genomic information into actionable insights, facilitating personalized health plans, enhancing drug discovery, and improving the efficiency of healthcare systems.

📋 Description

• Support organizational efforts to ensure utilization requests and claim submissions align with payers' medical necessity rules and requirements • Apply payer-specific medical necessity criteria to claims and prior authorization requests • Ensure clinical documentation supports the medical necessity of services provided • Work closely with claims, coding, appeals, billing, and other internal clinical teams • Lead cross-functional clinical billing integrity efforts for claims and invoices • Create clinical materials, including letters of medical necessity, pricing justification, and appeal templates • Review and decide prior authorization and claims denials for compliance, identifying documentation or coding discrepancies and appeal opportunities • Create and follow new processes or process changes to ensure compliance and intended outcomes • Integrate new technology and initiatives for summarization of clinical information for pre- and post-test teams • Provide insight into emerging use cases for exome and genome sequencing • Provide Market Access feedback on payer-specific coverage gaps and industry-standard misalignment • Analyze data trends using PowerBI, Tableau, and Smartsheets to identify opportunities for expanding clinical billing integrity efforts • Report directly to the Associate Director of Clinical Billing Integrity • No people-management responsibilities

🎯 Requirements

• Master's Degree in Genetic Counseling or related field • Minimum of 3 years of experience • Demonstrated experience in genetic and molecular billing operations and medical necessity criteria • Extensive experience with clinical documentation and medical coding (CPT, ICD-10, HCPCS) • Certification by the American Board of Genetic Counseling (ABGC) or equivalent • Genetic counseling state licensure as required by law • Lab and/or payer experience preferred • Experience with Medicare, Medicaid, and Commercial plans preferred • Excellent communication, organizational, and problem-solving skills • Reliable high-speed internet access • Ability to use standard office equipment including computer, phone, and video conferencing tools

🏖️ Benefits

• Competitive compensation and benefits reflecting local market practices and legal requirements in each country where GeneDx operates • Fully remote work from a home office or other suitable remote location • Flexible standard work schedule and hours established with the leader and adjustable to business needs • Standard office equipment including computer, phone, and video conferencing tools