Medical/Clinical Genetics Review Manager

Variantyx is a rapidly growing CLIA/CAP laboratory providing highly specialized genetic testing to clinicians and their patients. We have developed a proprietary diagnostic testing platform based on whole genome sequencing (WGS) that detects all major types of genetic changes, thereby reducing the false negative rate of testing, short-circuiting the prolonged diagnostic odyssey for patients with rare diseases and inherited cancers, and reducing the overall cost per diagnosis.

Position summary

In this high visibility role, you will be part of the Market Access and Reimbursement team that reports directly to the Associate Medical Director. This is a growing team of healthcare professionals who have a passion for and expertise in medical genetics and test utilization management. This is an inward-facing role, with no patient or provider contact. However, contact with payers will be an essential part of the position on a case-by-case basis. This position provides you with the opportunity to contribute to overall company growth by leveraging your medical/clinical genetics expertise and understanding of payer medical policies to advocate for patient access to appropriate genomic testing, while optimizing payer acceptance and reimbursement.

Responsibilities

  • Contribute to medical/clinical genetics review (“triage”) process to support  medical necessity of ordered testing using patient clinical information and payer coverage and reimbursement policies, ensuring patient access to genomic testing, and obtaining payer approval for coverage and reimbursement.
    • Review patient medical records within the context of ordered testing to optimize and advocate for necessary testing with payers.
    • Determine whether the ordered testing aligns with payer coverage and reimbursement policies by comparing patient’s clinical information with the payer policy and medical necessity criteria.
    • When testing does not align with payer coverage and reimbursement policies as ordered, recommend alternative, clinically appropriate testing strategies based on applicable payer policies, and clinical guidelines and evidence-based medicine from peer-reviewed literature.
    • Support pre-authorizations, claim submissions, and denial appeals by developing strong and succinct evidence-based rationale (letters of medical necessity, letters of appeal, etc.) that communicate the medical necessity of requested tests, and the differentiating value of the specific Variantyx  tests applicable to each case.
    • Maintain ongoing timeliness and throughput of quality deliverables.
  • Willingness and desire to learn and grow in the role to become an internal knowledge expert in the company.

Qualifications

  • Master’s Degree in Genetic Counseling, and/or MS or PhD in Human Genetics, Molecular Biology, or equivalent experience.
    • For genetic counselor applicants:
      • Master’s Degree from an ACGC accredited program
      • ABGC board-certified OR board-eligible
      • Active licensure in the state where you live, if applicable
  • Experience in medical review and/or utilization management, and/or hands-on experience in developing letters of medical necessity to support pre-authorization and payer reimbursement preferred.
  • Experience in HIPAA-regulated work environments.
  • Experience and working knowledge of the following:
    • Clinical genetic/genomic/next generation sequencing-based testing, including whole exome and whole genome Analyses.
    • Rare inherited diseases, neurology, metabolic, maternal fetal medicine, and/or cancer.
    • Available data sources for medical/clinical genetic and genomic information, and literature review (e.g., PubMed, GeneReviews, OMIM, ClinVar, guideline societies, health technology assessments).
  • Experience, familiarity, and/or willingness to quickly learn the following as relevant to Variantyx genomic testing:
    • Reimbursement environment and mechanisms for genomic/molecular pathology testing in the US including for commercial, Medicare, and Medicaid insurance segments.
    • How to locate, review, and interpret US payer medical policies.
    • Reimbursement coding for genomic testing (e.g., CPT, ICD-10-CM).
    • Working with healthcare utilization and health economic data to underscore the burden of disease (e.g., CMS data, AHRQ HCUPnet data).
  • Experience working in a cross-functional team environment including both technical and non-technical colleagues.

Requirements of role

  • Full-time position.
  • Excellent written and verbal communication skills with ability to adapt between technical and layperson communication.
  • Excellent organizational, time management skills, and ability to multitask and prioritize work.
  • Attention to detail and problem-solving skills.
  • Strong organizational and interpersonal skills.
  • Ability to work independently and as part of a broader team.
  • Business travel as needed (expected to be minimal).

To apply for this job email your details to humanresources@variantyx.com

Location:
Framingham, MA OR remote-based with travel to the Framingham office as needed.