Clinical Billing Integrity Lead Analyst

<p><span data-contrast="none"><span data-ccp-parastyle="paragraph" data-ccp-parastyle-defn="{&quot;ObjectId&quot;:&quot;aaed607e-c2a3-5841-9fb4-41037bfa0faf|1&quot;,&quot;ClassId&quot;:1073872969,&quot;Properties&quot;:[201342446,&quot;1&quot;,201342447,&quot;5&quot;,201342448,&quot;1&quot;,201342449,&quot;1&quot;,469777841,&quot;Times New Roman&quot;,469777842,&quot;Times New Roman&quot;,469777843,&quot;Times New Roman&quot;,469777844,&quot;Times New Roman&quot;,201341986,&quot;1&quot;,469769226,&quot;Times New Roman&quot;,268442635,&quot;24&quot;,469775450,&quot;paragraph&quot;,201340122,&quot;2&quot;,134233614,&quot;true&quot;,469778129,&quot;paragraph&quot;,335572020,&quot;1&quot;,335559740,&quot;240&quot;,201341983,&quot;0&quot;,134233118,&quot;true&quot;,134233117,&quot;true&quot;,469778324,&quot;Normal&quot;]}">GeneDx</span><span data-ccp-parastyle="paragraph">&nbsp;(Nasdaq: WGS) delivers personalized and actionable health insights to inform diagnosis, direct treatment, and improve drug discovery. The company is uniquely positioned to accelerate the use of genomic and large-scale clinical information to enable precision medicine as the standard of care.&nbsp;</span><span data-ccp-parastyle="paragraph">GeneDx</span><span data-ccp-parastyle="paragraph">&nbsp;is at the forefront of transforming healthcare through its industry-leading exome and genome testing and interpretation services, fueled by the world’s largest, rare disease data sets. For more information, please visit </span></span><a href="http://www.genedx.com/"><span data-contrast="none"><span data-ccp-charstyle="Hyperlink">www.genedx.com</span></span></a><span data-contrast="none"><span data-ccp-parastyle="paragraph">.</span></span><span data-ccp-props="{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335559738&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></p> <p><strong><span data-contrast="auto">Summary&nbsp;</span></strong> <span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></p> <p><span data-contrast="none">The&nbsp;</span><span data-contrast="none">Clinical Billing Integrity Lead Analyst</span><span data-contrast="none">&nbsp;will support the organization’s efforts in ensuring that all&nbsp;utilization&nbsp;requests and claim submissions align to payers' medical necessity rules and requirements. This role includes the application of payer-specific medical necessity criteria to claims and prior authorization requests, ensuring that clinical documentation supports the medical necessity of services provided. The lead analyst will work closely with claims, coding, appeals,&nbsp;billing&nbsp;and other internal clinical teams to ensure adherence to payer policies and regulatory guidelines, mitigating the risk of claim denials and improving success of appeals to ensure&nbsp;accurate&nbsp;reimbursement. This position directly reports to the Associate Director of Clinical Billing Integrity.</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></p> <p><strong><span data-contrast="auto">Job Responsibilities</span></strong><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></p> <ul> <li data-leveltext="" data-font="Symbol" data-listid="18" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span data-contrast="none">Lead clinical integrity efforts cross-functionally to ensure adherence to medical necessity rules and payer-specific requirements for claims and invoices.&nbsp;</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="18" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="2" data-aria-level="1"><span data-contrast="none">Create clinical materials as&nbsp;appropriate including&nbsp;letters of medical necessity, pricing&nbsp;justification&nbsp;and appeal templates&nbsp;&nbsp;</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="18" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="3" data-aria-level="1"><span data-contrast="none">Review and decision&nbsp;prior&nbsp;authorization and claims denials for compliance with medical necessity rules,&nbsp;identifying&nbsp;potential issues or discrepancies in clinical documentation and coding, and&nbsp;identifying&nbsp;opportunities for appeals.&nbsp;</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="18" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="4" data-aria-level="1"><span data-contrast="none">Create and follow new processes or process changes and to ensure compliance and intended outcomes as needed&nbsp;</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="18" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="5" data-aria-level="1"><span data-contrast="none">Integration of&nbsp;new technology&nbsp;and initiatives for summarization of clinical information for both pre-and post-test teams&nbsp;</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="18" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="6" data-aria-level="1"><span data-contrast="none">Provide insight into new and emerging use cases for exome and genome sequencing&nbsp;</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="18" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span data-contrast="none">Provide feedback for Market Access on payor specific gaps in coverage and/or misalignment to industry standards&nbsp;</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></li> <li data-leveltext="" data-font="Symbol" data-listid="18" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="8" data-aria-level="1"><span data-contrast="none">Analyze data trends, using a variety of data visualization tools (e.g.&nbsp;PowerBI, Tableau,&nbsp;Smartsheets) to find new opportunities for targeted expansion of clinical billing integrity team efforts</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></li> </ul> <p><strong><span data-contrast="auto">People Manager</span></strong><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></p> <ul> <li data-leveltext="·" data-font="Courier New" data-listid="11" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:1080,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Courier New&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;·&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span data-contrast="auto">No&nbsp;</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></li> </ul> <p><strong><span data-contrast="auto">Education, Experience, and Skills</span></strong><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></p> <ul> <li data-leveltext="·" data-font="Courier New" data-listid="15" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:1080,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Courier New&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;·&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span data-contrast="auto">Master's Degree in Genetic Counseling&nbsp;or related field&nbsp;</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></li> </ul> <ul> <li data-leveltext="·" data-font="Courier New" data-listid="15" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:1080,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Courier New&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;·&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="2" data-aria-level="1"><span data-contrast="auto">Minimum of 3 years of experience,&nbsp;lab&nbsp;and/or payer experience preferred.</span><span data-ccp-props="{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335559737&quot;:0,&quot;335559738&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:276}">&nbsp;</span></li> </ul> <ul> <li data-leveltext="·" data-font="Courier New" data-listid="15" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:1080,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Courier New&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;·&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="3" data-aria-level="1"><span data-contrast="auto">Demonstrated experience in genetic and molecular billing operations and medical necessity criteria.</span><span data-ccp-props="{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335559737&quot;:0,&quot;335559738&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:276}">&nbsp;</span></li> </ul> <ul> <li data-leveltext="·" data-font="Courier New" data-listid="15" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:1080,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Courier New&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;·&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="4" data-aria-level="1"><span data-contrast="auto">Extensive experience with clinical documentation and medical coding (CPT, ICD-10, HCPCS)&nbsp;</span><span data-ccp-props="{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335559737&quot;:0,&quot;335559738&quot;:0,&quot;335559739&quot;:0}">&nbsp;</span></li> </ul> <ul> <li data-leveltext="·" data-font="Courier New" data-listid="15" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:1080,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Courier New&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;·&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="5" data-aria-level="1"><span data-contrast="auto">Experience with Medicare, Medicaid, and Commercial&nbsp;plans&nbsp;preferred.</span><span data-ccp-props="{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335559737&quot;:0,&quot;335559738&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:276}">&nbsp;</span></li> <li data-leveltext="·" data-font="Courier New" data-listid="15" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:1080,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Courier New&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;·&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="6" data-aria-level="1"><span data-contrast="auto">Excellent communication, organizational, and problem-solving skills.</span><span data-ccp-props="{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335559737&quot;:0,&quot;335559738&quot;:0,&quot;335559739&quot;:0}">&nbsp;</span></li> </ul> <p><strong><span data-contrast="auto">Certificates, Licenses, Registrations</span></strong><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></p> <ul> <li data-leveltext="·" data-font="Courier New" data-listid="16" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:1080,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Courier New&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;·&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span data-contrast="auto">Certification by the American Board of Genetic Counseling (ABGC) or equivalent</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></li> <li data-leveltext="·" data-font="Courier New" data-listid="16" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:1080,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Courier New&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;·&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="2" data-aria-level="1"><span data-contrast="auto">Genetic counseling state licensure as required by law.</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></li> </ul> <p><strong><span data-contrast="auto">Work Environment</span></strong><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></p> <p><span data-contrast="auto">This is&nbsp;a fully&nbsp;remote position. The employee will work from a home office or&nbsp;other&nbsp;suitable remote location with reliable high-speed internet access. Work is performed in a climate-controlled environment using standard office equipment including computer, phone, and video conferencing tools.&nbsp;Your standard work schedule and hours will be&nbsp;established&nbsp;in collaboration with your leader and may be adjusted to align with evolving business needs.</span><span data-ccp-props="{&quot;335559685&quot;:0}">&nbsp;</span></p> <p>&nbsp;</p> <p><span data-ccp-props="{&quot;335559685&quot;:0}">#LI-REMOTE</span></p> <p>&nbsp;</p><div class="content-pay-transparency"><div class="pay-input"><div class="title">Pay Transparency, Budgeted Range</div><div class="pay-range"><span>$100,000</span><span class="divider">&mdash;</span><span>$120,000 USD</span></div></div></div><div class="content-conclusion"><div class="column _8-col center-element _12-col-tab"> <div class="margin-bottom margin-24"> <h3 class="heading-l">A culture that plays to win, because patients are counting on us</h3> </div> </div> <div class="column _8-col _12-col-tab"> <p>At GeneDx, we're driven by urgency and purpose: helping patients get diagnosed earlier. Our mission, to empower everyone to live their healthiest life through genomics, drives our team to make a tangible impact each day – and shapes our culture where high standards, strong teamwork, and meaningful ownership are the norm. We act with intention, support one another, and deliver work we're proud to put our names on.<br><br><strong>Here’s what you can expect day to day:</strong><br><br>1. Play like a champion (step up, redefine what’s possible, own it)</p> <p class="text-l">We bring energy, focus, and a bias for action. We step up, take initiative, and deliver on our commitments – with quality, speed, and care.<br><br></p> <div class="card-number">2.&nbsp;Think bigger (stretch beyond, courage not consensus)</div> <p class="text-l">We push past the obvious. We challenge assumptions, raise the bar, and make thoughtful, decisive calls — choosing progress over perfection.<br><br></p> <div class="card-number">3.&nbsp;Grow fast (be curious, speak up, be agile)</div> <p class="text-l">We stay curious, ask questions, and share direct feedback with respect. We adapt quickly and keep learning through collaboration and continuous improvement.<br><br>If you’re motivated by meaningful work, a fast-moving environment, and teammates who care deeply about outcomes, you’ll thrive at GeneDx.</p> </div> <div>At GeneDx, we believe in taking care of our people. We provide competitive compensation and benefits that reflect local market practices and legal requirements in each country where we operate, helping employees thrive both professionally and personally.</div> <p>We welcome everyone regardless of their background. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, gender, gender identity, sexual orientation, protected veteran status, disability, age, and other characteristics protected by law.</p> <p><strong>GeneDx is a place where people from all backgrounds can make an impact.</strong></p> <p><strong><br></strong>All privacy policy information can be found <a href="https://www.genedx.com/privacy" target="_blank">here</a>.</p></div>