Clinical Billing Integrity Lead Analyst
Core
Lead clinical integrity efforts to ensure claims and prior authorization requests align with payer medical necessity rules, mitigating denials and improving reimbursement for genomic testing services.
Role type
Senior IC clinical billing integrity analyst
Builds
Accurate reimbursement for exome and genome sequencing services
Domain
Healthcare / Genomics / Medical Billing
Deliverable
client delivery
Required skills
Medical necessity criteria application, Clinical documentation review, Medical coding (CPT, ICD-10, HCPCS), Data analysis and visualization (PowerBI, Tableau, Smartsheets), Process improvement, Cross-functional collaboration
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
