Medical Billing Specialist

Job Description

Job Description

Medical Billing Specialist – Denials & Appeals

CytoGenX Corp.

Full-Time
Competitive Salary (Based on Experience)
Medical • Dental • Vision • Paid Time Off • 401(k)

Join a Growing Leader in Prenatal & Molecular Diagnostics

CytoGenX Corp. is a rapidly growing specialty clinical laboratory dedicated to providing advanced prenatal, molecular genetic, cytogenetic, and genomic testing that helps physicians deliver timely, life-changing care to patients and families.

We are seeking an experienced Medical Billing Specialist – Denials & Appeals to join our Revenue Cycle team. This individual will play a critical role in maximizing reimbursement by resolving denied and underpaid claims while working with commercial insurers, Medicare, Medicaid, and managed care organizations.

If you enjoy solving complex reimbursement challenges and want to work in an organization where your expertise directly impacts patient care, we'd like to meet you.

Position Responsibilities

As a Medical Billing Specialist, you will:

• Investigate and resolve claim denials for molecular genetics, cytogenetics, prenatal diagnostics, pathology, and laboratory services.
• Review insurance remittance advice (EOBs/ERAs), payer correspondence, and denial reports to identify reimbursement issues.
• Prepare and submit first- and second-level appeals with appropriate medical documentation, coding justification, and payer-specific requirements.
• Correct claim edits and clearinghouse rejections.
• Monitor claim status and ensure timely follow-up on outstanding accounts receivable.
• Research payer medical policies and coverage guidelines.
• Work closely with laboratory operations, client services, coding, and utilization management teams to resolve billing discrepancies.
• Review medical necessity documentation and diagnosis coding to support claim payment.
• Process corrected claims, reconsiderations, and refund requests.
• Maintain detailed documentation of all payer communications.
• Identify denial trends and recommend workflow improvements that reduce future denials.
• Assist with special reimbursement projects involving new molecular and genetic testing.

Preferred Qualifications

• High School Diploma required; Associate's or Bachelor's degree preferred.
• Medical Billing or Coding Certification (preferred).
• Minimum 2 years of medical billing and insurance follow-up experience.
• Experience with laboratory billing strongly preferred.
• Experience with molecular diagnostic, cytogenetic, prenatal, pathology, or genetic testing billing is highly desirable.
• Working knowledge of:
• • Independent clinical laboratory billing
  • Molecular and genetic testing reimbursement
  • Medicare and commercial payer claims
  • CPT, ICD-10-CM MolDX and Z-codes
  • Modifier usage
  • Prior authorizations
  • Medical necessity requirements
  • Denials and appeals
  • Coordination with ordering physicians
  • Revenue cycle management
  • Clearinghouses
  • Laboratory Information Systems (LIS)
• Experience appealing denials from:
• • Medicare
  • Medicaid
  • UnitedHealthcare/Optum
  • Aetna
  • Cigna
  • Blue Cross Blue Shield
  • Healthfirst
  • Other commercial payers
• Familiarity with prior authorization and utilization management processes.
• Strong analytical, organizational, and communication skills.
• Proficiency with Microsoft Excel and billing software.
  

Ideal Candidate

The ideal candidate is someone who:

• Enjoys solving complex reimbursement challenges.
• Has exceptional attention to detail.
• Understands laboratory revenue cycle management.
• Can independently manage a high-volume denial workload.
• Works well in a collaborative environment.
• Is committed to continuous learning as payer policies evolve.