Clinical Billing Integrity Lead Analyst

Lead clinical billing integrity efforts to ensure adherence to medical necessity rules and payer-specific requirements for claims and prior authorization requests. Develop clinical materials such as letters of medical necessity and pricing justification; review and decide on denials and prior authorizations; identify discrepancies in clinical documentation and coding; implement new processes to ensure compliant outcomes. Leverage data visualization tools (PowerBI, Tableau) to spot trends and opportunities for targeted expansion of billing integrity efforts. Role reports to the Associate Director and is fully remote. Requires ABGC certification and state licensure as applicable, with 3+ years in genetic/molecular billing operations. Involves collaboration with claims, coding, appeals, and other clinical teams, and contributes to improving reimbursement and reducing denials, while supporting payer policy alignment and regulatory compliance.