Genetic Counselor, Benefits Investigation
On-site · Coppell, Texas, United States
Job Summary
Genetic Counselor in Benefits Investigation to review patient cases, develop Letters of Medical Necessity (LMNs), interpret payer requirements, and coordinate with ordering clinicians and genetic counseling partners to obtain information needed for prior authorization and coverage decisions. Work closely with Patient Benefit Specialists to understand benefits, provide appeals and LMNs as needed, and assist the Sales team by communicating authorization denial trends. Collaborate with ordering providers and genetic counseling teams to obtain clinical notes, pedigrees, test indications, and supporting documentation required by insurers. Lead projects related to denials, pre-authorizations, client requirements, and acts as a subject-matter expert on appeals and authorizations. Establish a strong partnership with Sales and Client Services to improve authorization performance and track outcomes of payment resolutions and negotiated claims for monthly leadership reporting.
Required Qualifications
- Master’s degree in Genetic Counseling from an ABGC-accredited program
- Familiarity with payer guidelines and genetic testing reimbursement challenges is preferred
- Prior experience in insurance coordination, prior authorization, utilization management, or revenue cycle processes is preferred
- Excellent communication skills (oral and written) and attention to detail
- Exceptional analytical and critical-thinking skills, with a focus on problem-solving
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