Lead Genetic Testing and Laboratory SME

This is a fully remote position, open to applicants in United States.

📋 Description

• Offer extensive expertise in molecular diagnostics (both germline and somatic), next-generation sequencing (NGS), and multigene panels, along with familiarity in laboratory billing practices (CPT/HCPCS, PLA codes, stacking).

• Serve as the main clinical collaborator with CST analysts to interpret clinical intent into prepay-editable rule logic.

• Lead or co-lead the creation of Coding Validation (CV) edits and postpay data-mining initiatives across laboratory and genetic testing.

• Present rule logic and strategy to payer clients; simplify intricate genetic testing concepts into understandable clinical narratives and highlight financial impacts/savings opportunities.

⛳️ Requirements

• Master’s degree in Genetic Counseling or a related discipline.

• Board certification is preferred (ABGC or equivalent).

• 6-8+ years of experience in genetic counseling, molecular diagnostics, and/or laboratory utilization management.

• Profound understanding of CPT/HCPCS coding for laboratory/genetic testing, including the complexities of NGS panel billing and common billing practices.

• Familiarity with prior authorization and utilization management frameworks as they pertain to genetic testing and laboratory services.

🏝️ Benefits

• Health insurance.

• Dental insurance.

• Vision insurance.

• Disability insurance.

• Life insurance coverage.

• 401(k) savings plans.

• Paid family leave.

• 9 paid holidays each year.

• 17-27 days of Paid Time Off (PTO) annually, based on specific level and length of service with Cotiviti.