Clinical Billing Integrity Lead Analyst

Remotedxb; Dubai; On-site; AED 250,000 - 450,000; Full time

Job summary

GeneDx in the United Arab Emirates seeks a seasoned genetic counseling professional to lead clinical integrity, develop medical necessity materials, and manage prior authorizations and denials. The role involves cross-functional collaboration, process design, and adoption of new technologies for data-driven decisions.

Responsibilities include generating MN letters, pricing justifications, and appeals templates, with a focus on exome/genome sequencing applications and payer-specific coverage

Qualifications

• Master's degree in Genetic Counseling or related field.
• ABGC certification or equivalent preferred.
• Genetic counseling licensure as required by law where applicable.
• Experience with genetic and molecular billing operations and medical necessity criteria.

Responsibilities

• Lead cross-functional efforts to ensure medical necessity rules and payer-specific requirements.
• Create clinical materials such as letters of medical necessity, pricing justification and appeal templates.
• Review and decide prior authorizations and denials for compliance with medical necessity rules.
• Develop new processes to ensure compliance and intended outcomes.
• Integrate technology to summarize clinical information.
• Provide insights on new use cases for exome and genome sequencing.
• Analyze data trends using PowerBI, Tableau, or Smartsheets to identify expansion opportunities.

Skills

Genetic counseling

Medical coding CPT ICD-10 HCPCS

Data analysis

Regulatory compliance

PowerBI

Education

Master's degree in Genetic Counseling

Tools

PowerBI

Tableau

Smartsheets

Job description

Responsibilities

• Lead clinical integrity efforts cross-functionally to ensure adherence to medical necessity rules and payer-specific requirements for claims and invoices
• Create clinical materials including letters of medical necessity, pricing justification and appeal templates
• Review and decision prior authorization and claims denials for compliance with medical necessity rules
• Create and follow new processes to ensure compliance and intended outcomes
• Integrate new technology for summarization of clinical information
• Provide insight into new and emerging use cases for exome and genome sequencing
• Provide feedback for Market Access on payor specific gaps in coverage
• Analyze data trends using PowerBI, Tableau, or Smartsheets to find new opportunities for targeted expansion

Requirements

• Master's Degree in Genetic Counseling or related field
• Minimum of 3 years of experience, lab and/or payer experience 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)
• Experience with Medicare, Medicaid, and Commercial plans preferred
• Certification by the American Board of Genetic Counseling (ABGC) or equivalent
• Genetic counseling state licensure as required by law

About the Company

GeneDx delivers personalized and actionable health insights to inform diagnosis, direct treatment, and improve drug discovery through genomic and large-scale clinical information.