Clinical Billing Integrity Lead Analyst (Medtech)

TL;DR

Clinical Billing Integrity Lead Analyst (Medtech): Ensuring claim submissions and utilization requests align with payer medical necessity rules with an accent on clinical documentation and regulatory compliance. Focus on mitigating claim denials, improving appeal success rates, and analyzing data trends to expand billing integrity efforts.

Location: Remote (US)

Salary: $100,000 - $120,000 USD

Company

hirify.global delivers personalized health insights to inform diagnosis and treatment through genomic and large-scale clinical information.

What you will do

• Lead cross-functional efforts to ensure adherence to medical necessity rules for claims and invoices.
• Create clinical materials including letters of medical necessity and appeal templates.
• Review and decision prior authorization and claims denials for compliance.
• Implement and refine processes to ensure regulatory compliance and intended outcomes.
• Integrate new technology for clinical information summarization.
• Analyze data trends using PowerBI, Tableau, and Smartsheets to find expansion opportunities.

Requirements

• Master's Degree in Genetic Counseling or a related field.
• Minimum of 3 years of experience, preferably in lab or payer environments.
• Demonstrated experience in genetic/molecular billing operations and medical necessity criteria.
• Extensive knowledge of medical coding (CPT, ICD-10, HCPCS).
• Certification by the American Board of Genetic Counseling (ABGC) or equivalent.
• Genetic counseling state licensure as required by law.

Culture & Benefits

• Fully remote work environment with flexible scheduling.
• Comprehensive Health, Dental, Vision, and Life insurance.
• 401k Retirement Savings Plan.
• Paid Time Off (PTO) and employee discounts.
• Collaborative environment focused on cutting-edge science and patient care.