Genetic Counselor, Benefits Investigation

Fulgent Therapeutics•Coppell, TX

18d

About The 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.
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.

Nice To Haves

3-5 years’ of clinical and/or laboratory experience is a plus.

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.