Clinical Billing Integrity Lead Analyst

Location: Fully remote

Salary: $100,000–$120,000 USD per year

Company

hirify.global delivers genomic testing, interpretation services, and clinical insights that support diagnosis, treatment decisions, precision medicine, and drug discovery.

What you will do

• Lead cross-functional clinical billing integrity initiatives covering claims, invoices, utilization requests, and payer-specific requirements.
• Create letters of medical necessity, pricing justifications, appeal templates, and other clinical materials.
• Review prior authorizations and claim denials for medical necessity, documentation, and coding compliance, identifying appeal opportunities.
• Develop and implement process changes that improve compliance and intended outcomes.
• Support technology initiatives for summarizing clinical information and provide insights into emerging use cases for exome and genome sequencing.
• Analyze billing and coverage trends with Power BI, Tableau, Smartsheet, and similar visualization tools to identify opportunities for targeted improvements.

Requirements

• Master’s degree in Genetic Counseling or a related field.
• At least 3 years of experience; laboratory or payer experience is preferred.
• Experience with genetic and molecular billing operations and medical necessity criteria.
• Extensive experience with clinical documentation and medical coding, including CPT, ICD-10, and HCPCS.
• ABGC certification or equivalent, plus genetic counseling state licensure where required by law.
• Strong communication, organizational, and problem-solving skills.

Nice to have

• Experience with Medicare, Medicaid, and commercial health plans.
• Laboratory or payer experience.

Culture & Benefits

• Fully remote work from a home office or other suitable location with reliable high-speed internet.
• Work is performed using standard office equipment and video conferencing tools.
• Schedule and working hours are established with the leader and may change with business needs.
• Competitive compensation and benefits aligned with local market practices and legal requirements.
• Culture focused on ownership, teamwork, continuous learning, direct feedback, and meaningful patient impact.