Genetic Counselor, Benefits Investigation

About This Role

The Genetic Counselor will be a key member of the Benefits Investigation division, supporting internal teams and external providers to secure insurance coverage for Next Generation Sequencing (NGS) testing. This role involves reviewing patient cases, developing Letters of Medical Necessity, interpreting payer requirements, and coordinating with clinicians to obtain necessary information for prior authorizations and coverage decisions.

Responsibilities

• Develop in-depth knowledge of payor policies and requirements to assist providers with key information and clear reasons why testing is required
• Assist with medical necessity letters for authorizations and appeals
• Work closely with Patient Benefit Specialists to understand benefits and provide appeals as needed
• Provide Sales Team with authorization denial client trends and data, and partner to educate clients on requirements
• Work closely with ordering providers and genetic counseling teams to obtain clinical notes, pedigrees, test indications, and supporting documentation
• Serve as a subject matter expert on appeals and authorizations
• Establish a strong partnership with Sales and Client Services to improve authorization performance
• Track outcomes of payment resolutions, appeals, and negotiated claims to ensure goals are met
• Collect key data metrics, and present monthly to the senior leadership team

Requirements

• Master's degree in Genetic Counseling from an accredited American Board of Genetic Counseling (ABGC) training program
• ABGC-CGC Certified Genetic Counselor
• 3-5 years’ experience as a Genetic Counselor
• In-depth knowledge of healthcare and insurance regulations, policies, and procedures
• Exceptional analytical and critical-thinking skills
• Excellent communication skills and attention to detail
• Familiarity with payer guidelines and genetic testing reimbursement challenges
• Prior experience in insurance coordination, prior authorization, utilization management, or revenue cycle processes

Qualifications

• Master's degree in Genetic Counseling from an accredited American Board of Genetic Counseling (ABGC) training program
• 3-5 years’ experience as a Genetic Counselor, with a plus for clinical and/or laboratory experience

Nice to Have

• 3-5 years’ of clinical and/or laboratory experience

Certifications