The Insurance and Billing Genetic Counselor is responsible for supporting accurate reimbursement and reducing denials related to genetic testing and medical necessity. This role combines clinical expertise with knowledge of insurance requirements, providing critical support for prior authorization appeals, peer-to-peer discussions, and denial resolution. The counselor will collaborate with billing, revenue cycle, clinical teams and payers to ensure appropriate coverage and timely payment for genetic services.


Duties/Responsibilities:

Peer-to Peer & Clinical Support

• Participate in peer-to-peer reviews with insurance medical directors to clarify clinical utility, testing indications, and medical necessity for genetic tests.
• Prepare clinical summaries, case justifications, and supporting documentation for peer-to-peer discussions.

Denial & Appeals Management

• Review insurance denials related to genetic testing and determine appropriate appeal strategies.
• Draft and submit appeal letters, including medical necessity explanations, literature summaries, and clinical rationale.
• Track and follow up on outstanding appeals to ensure timely resolution.
• Identify denial trends and work with the billing/revenue cycle team to implement proactive solutions.

Billing & Authorization Support

• Support prior authorization team with clinical guidance, including test indication reviews and correct CPT/ICD-10 code usage.
• Communicate with laboratory, payers and ordering providers to clarify documentation or clinical details needed for coverage.
• Maintain an in-depth understanding of payer policies, coverage criteria, and industry changes related to genetic testing indications.

Collaboration & Education

• Partner with billing, scheduling, and clinical teams to reduce preventable denials and streamline the authorization process.
• Provide education to clinicians regarding payer requirements, documentation standards, and testing indications.
• Serve as a liaison between the healthcare providers/clinicians team and revenue cycle departments.

Documentation & Quality Improvement

• Maintain accurate documentation of peer-to-peer discussions, appeals and case outcomes.
• Participate in audits, quality initiatives, and process improvements focused on reducing denial rates and improving reimbursement.
• Use reporting tools or dashboards to track metrics related to denial rates, appeals success, and turnaround times.

Required Skills/Abilities:

• Experience conducting peer-to-peer discussions or appeals.
• Prior experience in revenue cycle, billing, utilization management, or payer review preferred.
• Knowledge of payer policies related to genetic and genomic testing.
• Strong understanding of genetic testing workflows and clinical indications.
• Excellent communication skills, especially in explaining complex clinical concepts to payers and non-clinical staff.
• Strong organizational and analytical skills.
• Proficient in Microsoft Office Suite or related software; Basic understanding of clerical procedures and systems such as recordkeeping and filing.

Education and Experience:

• Master’s degree in Genetic Counseling
• Board certification or board-eligible with plan for certification
• Minimum one-year clinical experience as Genetic Counselor
• Candidates must be licensed or eligible for licensure to practice genetic counseling within the state of South Carolina.

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer
• Must be able to lift up to 15 pounds at times

Please include a cover letter when applying. Click here (www.GGC.org/careers) to apply.

Remote work eligible; South Carolina preferred, though other locations may be considered.