State Licensed Clinical Billing Analyst

Job Summary

Leading clinical integrity efforts, the full-time remote State Licensed Clinical Billing Analyst will ensure compliance with medical necessity rules and payer-specific requirements for claims and invoices while collaborating with internal teams to mitigate claim denials and improve reimbursement success.

Key responsibilities

• Lead cross-functional efforts to ensure adherence to medical necessity rules and payer requirements for claims
• Create clinical materials, including letters of medical necessity and appeal templates
• Review prior authorization and claims denials for compliance, identifying discrepancies and opportunities for appeals

Required qualifications

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