Job Description:
• Develop, implement, and manage a revenue cycle management clinical support function focused on prior authorizations and appeals for genetic testing services.
• Lead, coach, and develop a team of certified genetic counselors, establishing workflows, performance expectations, and quality standards.
• Oversee authorization and appeal activities to improve approval rates, reduce turnaround times, and support timely patient access to testing.
• Partner with billing, finance, laboratory operations, and payer strategy teams to align clinical support workflows with revenue cycle processes.
• Analyze authorization and appeal data to identify denial trends and implement process improvements.
• Leverage AI-enabled tools and automation to improve efficiency and scalability of revenue cycle workflows.
• Ensure compliance with payer policies, regulatory requirements, and internal quality standards.
• Perform other duties as assigned and comply with all company policies and procedures.
Requirements:
• Master of Science or Master of Arts in Genetic Counseling from an ACGC‑accredited program or equivalent.
• Board‑certified Genetic Counselor.
• Minimum of 5 years of professional experience as a genetic counselor, including experience supporting revenue cycle management activities such as prior authorizations and appeals.
• Minimum of 1 year of people management or team leadership experience.
• Demonstrated experience interpreting payer policies and supporting insurance authorization and appeals processes.
• Strong analytical, organizational, and communication skills.
• Equivalent combination of education and experience may be considered.
• Experience in a commercial genetic testing laboratory or healthcare diagnostics environment (preferred).
• Experience building or scaling a new functional team or service area (preferred).
• Experience using or implementing AI‑enabled tools, automation, or decision‑support technologies within clinical or revenue cycle workflows (preferred).
• Familiarity with revenue cycle systems, payer portals, and customer relationship management platforms (preferred).
Benefits:
• Compliance with clinical and laboratory safety requirements