Conseiller clients en assurance gérant les activités pour les clients particuliers et professionnels dans une agence dynamique. Accueillir, traiter les demandes et gérer les dossiers clients de manière autonome.
About the role
- Genetic Counselor Review Associate conducting medical necessity reviews for genetic testing at Carelon Medical. Collaborating with healthcare providers and ensuring compliance with clinical guidelines.
Responsibilities
- Conducting medical necessity review in adherence to guidelines
- Clearly documenting clinical review and other case interactions
- Assists physician reviewers with clinical interpretation questions
- Addresses questions from ordering provider offices via phone
- Provides specific constructive feedback on Carelon guidelines
- Contributes to team projects for accuracy and efficiency
- Receives pre-authorization requests from front-line intake
- Determines if initial clinical information meets medical necessity criteria
- Works closely with medical directors for recommendations
- Maintains confidentiality of patient and provider specific information
Requirements
- Requires MA/MS from an ACGC accredited program
- ABGC board certification required
- Experience working in a cross functional team environment preferred
- Experience and/or familiarity with reimbursement coding for genomic testing preferred
- 2 years experience in lab or genetic counseling
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
Job title
Job type
Experience level
Salary
Degree requirement
No Education Requirement
Location requirements
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