Genetic Counselor, Benefits Investigation

Fulgent Therapeutics•Coppell, TX

18h

About The Position

Inform Diagnostics, a Fulgent Genetics Company , is a nationally recognized diagnostics laboratory focused on anatomic pathology subspecialties including gastrointestinal pathology, dermatopathology, urologic pathology, hematopathology, and breast pathology. Founded in 2011, our parent entity, Fulgent Genetics, has evolved into a premier, full-service genomic testing company built around a foundational technology platform. Through our diverse testing menu, Fulgent is focused on transforming patient care in oncology, anatomic pathology, infectious and rare diseases, and reproductive health. We believe that by providing a wide range of effective, flexible testing options in conjunction with best-in-class service and support, we can redefine the way medicine is managed for patients and clinicians alike. Since integrating with our therapeutic development business, Fulgent is also developing drug candidates for treating a broad range of cancers using a novel nanoencapsulation and targeted therapy platform. By merging our fields of expertise, we aim to become a fully integrated precision medicine company. Summary of Position The Genetic Counselor will serve as a key member of the Benefits Investigation division. This role supports the internal benefits investigation team and external providers to facilitate insurance coverage for NGS testing. The counselor will apply expertise to review patient cases, develop Letters of Medical Necessity (LMNs), interpret payer requirements, and coordinate with ordering clinicians and genetic counseling partners to obtain information needed for prior authorization and coverage decisions.

Requirements

A Master's degree in Genetic Counseling from an accredited American Board of Genetic Counseling (ABGC) training program.
(ABGC-CGC) Certified Genetic Counselor by American Board of Genetic Counseling is a hard requirement.
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, with a focus on problem-solving.
Excellent communication skills (oral and written) 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.

Nice To Haves

3-5 years’ of clinical and/or laboratory experience is a plus.
Ability to work in a fast-paced environment and adaptable to change.
Must lead by example by modeling our core values and effectively communicate to peer team members.

Responsibilities

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.
Work closely with our Patient Benefit Specialists to understand benefits and provide appeals and letters of medical necessity as needed for patient care and testing.
Provide Sales Team with authorization denial client trends and data.
Partner with Sales to educate clients on requirements needed to authorize submissions.
Work closely with ordering providers and genetic counseling teams to obtain clinical notes, pedigrees, test indications, and additional supporting documentation required by insurers.
Work on projects related to denials, pre-authorizations, client requirements, and all others assigned.
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.
Perform other duties as assigned.