Express Scripts Prior Authorization Jobs in Arlington, TX

About Us

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.

Key Job Elements

• 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.

Knowledge/Experience

• A Master’s degree in Genetic Counseling from an accredited American Board of Genetic Counseling (ABGC) training program.
• Familiarity with payer guidelines and genetic testing reimbursement challenges is preferred.
• Prior experience in insurance coordination, prior authorization, utilization management, or revenue cycle processes is preferred.
• 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.
• Exceptional analytical and critical-thinking skills, with a focus on problem-solving.
• Excellent communication skills (oral and written) and attention to detail.

Supervisory Responsibilities

• None

Reports To

• Supervisor of Genetic Counseling, Benefits Investigation

Environment

Fulgent Therapeutics LLC is an Equal Employment Opportunity Employer.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. The term “qualified individual with a disability” means an individual with a disability who, with or without reasonable accommodation, can perform the essential functions of the position.

Please note that Fulgent (and its affiliated companies, including Inform Diagnostics and CSI Laboratories) does not accept unsolicited information and/or resumes from search firms or agencies for our job postings. Search firms or agencies without an applicable contract and/or express approval to recruit for the role in question — that choose to submit a resume or client information to our career page or to any employee of Fulgent — will not be eligible for payment of any fee(s), and any associated shared data will become the property of Fulgent.