Description

Our mission at Progenity is simple: to help healthcare providers and patients prepare for life. We provide the most advanced molecular technology and the highest levels of service to guide patient care at critical life stages. We continually seek people with the motivation and skills to advance our mission.

The Clinical Managed Care (CMC) Coordinator will service as a scientific and clinical expert between Progenity and Major Medical Associations, Insurers/Payors, Healthcare Professionals and Key Opinion Leaders/External Experts. The CMC Coordinator works as part of a team of managed care experts and genetic counselors and is responsible for supporting payor strategy and relationship development and will serve as the clinical subject matter expert on payor policy.

RESPONSIBILITIES

  • Leads the development, enhancement, execution and regular updating of a payor policy database.
  • Supports new products as it relates to clinical payor messaging, applying for new codes to gain coverage based on clinical evidence, and coordinating go to market payor strategy.
  • Provides education to payors to support partnerships, in-network contracts and medically appropriate testing.
  • Reviews data and denials to identify the cause and strategies to overcome them.
  • Works with a team to implement best practices, strategize solutions to meet the changing payor landscape and identify areas for improvement.
  • Functions as a resource for problem-solving and process improvement.
  • Participates in routine collaboration, strategic planning and team communication with the Director of Managed Care, Medical Affairs leadership, billing and other teams.
  • Actively pursues and maintaisn CEUs and Genetic Counseling board certification as required.
  • Understands when to triage concerns or issues up to high departmental managers.
  • Contributes to a positive team dynamic of high-energy collaboration and operational excellence.

This list of duties and responsibilities is not all inclusive and may be expanded to include other duties and responsibilities, as deemed necessary.

REQUIREMENTS

  • Master’s Degree in Genetic Counseling or similar clinical training ABGC/ABMG or similar certification
  • Ability to interpret and communicate payor coverage and policy for specific tests to members across the organization internally.

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