Job Details

A company is looking for a Clinical Billing Integrity Lead Analyst to ensure compliance with medical necessity rules and payer requirements for claims and prior authorization requests.Key ResponsibilitiesLead clinical integrity efforts to ensure adherence to medical necessity rules and payer-specific requirementsCreate clinical materials including letters of medical necessity and appeal templatesReview prior authorization and claims denials for compliance, identifying issues in clinical documentation and codingRequired Qualifications, Training, and EducationMaster's Degree in Genetic Counseling or related fieldMinimum of 3 years of experience, preferably in lab and/or payer settingsExperience in genetic and molecular billing operations and medical necessity criteriaExtensive knowledge of clinical documentation and medical coding (CPT, ICD-10, HCPCS)Experience with Medicare, Medicaid, and Commercial plans preferred