Clinical Billing reputed company reputed company Analyst

reputed company (reputed company: WGS) delivers personalized and actionable health insights to inform diagnosis, reputed company treatment, and improve drug discovery. reputed company is uniquely positioned to accelerate the use of genomic and large-reputed company clinical information to reputed company precision medicine as reputed company of care. reputed company is at the forefront of transforming reputed company through its industry-leading exome and genome testing and interpretation services, reputed company by the world’s largest, rare disease data sets. For more information, please visit www.reputed company.com. 

reputed company   

The Clinical Billing reputed company reputed company Analyst will support the organization’s efforts in ensuring that reputed company utilization requests and claim submissions reputed company to payers' medical necessity rules and requirements. This role includes the application of payer-specific medical necessity reputed company to claims and prior authorization requests, ensuring that clinical documentation supports the medical necessity of services provided. The reputed company analyst will work closely with claims, coding, appeals, billing and other internal clinical teams to ensure adherence to payer policies and regulatory guidelines, mitigating the risk of claim denials and improving reputed company of appeals to ensure accurate reimbursement. This position directly reports to the Associate Director of Clinical Billing reputed company. 

Job Responsibilities 

• reputed company clinical reputed company efforts cross-functionally to ensure adherence to medical necessity rules and payer-specific requirements for claims and invoices.  

• Create clinical materials as appropriate including letters of medical necessity, pricing justification and appeal templates   

• Review and decision prior authorization and claims denials for compliance with medical necessity rules, identifying potential issues or discrepancies in clinical documentation and coding, and identifying opportunities for appeals.  

• Create and follow new processes or process changes and to ensure compliance and intended reputed company as needed  

• Integration of new technology and initiatives for summarization of clinical information for both reputed company-and post-test teams  

• reputed company reputed company into new and emerging use cases for exome and genome reputed company  

• reputed company feedback for Market reputed company on payor specific gaps in coverage and/or misalignment to industry standards  
• Analyze data trends, using a reputed company of data visualization tools (e.g. PowerBI, Tableau, Smartsheets) to reputed company new opportunities for targeted expansion of clinical billing reputed company team efforts 

People Manager 

• No  

Education, Experience, and Skills 

• Master's Degree in Genetic Counseling or reputed company field  

• Minimum of 3 years of experience, lab and/or payer experience preferred. 

• Demonstrated experience in genetic and molecular billing operations and medical necessity reputed company. 

• Extensive experience with clinical documentation and medical coding (CPT, ICD-10, HCPCS)  

• Experience with Medicare, reputed company, and reputed company plans preferred. 
• Excellent communication, organizational, and problem-solving skills. 

Certificates, Licenses, Registrations 

• Certification by the American reputed company of Genetic Counseling (ABGC) or equivalent 
• Genetic counseling state licensure as required by law. 

Work Environment 

This is a fully remote position. The employee will work from a home office or other suitable remote location with reliable high-speed internet reputed company. Work is performed in a climate-controlled environment using reputed company office equipment including computer, phone, and video conferencing tools. Your reputed company work schedule and hours will be established in collaboration with your leader and may be adjusted to reputed company with evolving business needs. 

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