Genomics Billing Integrity Lead

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

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