Clinical Billing Integrity Lead Analyst
Core
Ensure utilization requests and claim submissions align with payer medical necessity rules to mitigate denials and improve reimbursement for genomic testing services.
Role type
Senior IC clinical billing integrity analyst
Builds
Accurate claims and prior authorization requests for exome and genome sequencing services
Domain
Healthcare / Genomics / Medical Billing
Required skills
Medical necessity criteria application, Clinical documentation review, Medical coding (CPT, ICD-10, HCPCS), Claims and prior authorization analysis, Data trend analysis, Process improvement
Preferred skills
Lab operations experience, Payer operations experience, Medicare/Medicaid/Commercial plan knowledge
Technologies
PowerBI, Tableau, Smartsheets
Responsibilities
Review prior authorization and claims denials for compliance, Create letters of medical necessity and appeal templates, Analyze data trends to identify expansion opportunities, Integrate new technology for clinical information summarization, Provide feedback on payor coverage gaps, Lead cross-functional clinical integrity efforts
Seniority
Senior, hands-on IC