Lead Genetic Testing and Laboratory SME

Cotiviti

Genetic Testing & Laboratory SME responsible for clinical authority and rule logic development at Cotiviti. Supporting payment integrity related to genetic testing and laboratory services.

Posted 6/6/2026full-timeRemote • 🇺🇸 United StatesSenior💰 $110,000 - $140,000 per yearWebsite

About the role

Key responsibilities & impact

Provide deep expertise in molecular diagnostics (germline and somatic), next-generation sequencing (NGS) and multigene panels, and laboratory billing practices (CPT/HCPCS, PLA codes, stacking)
Act as the primary clinical partner to CST analysts to translate clinical intent into prepay-editable rule logic
Lead or co-lead development of Coding Validation (CV) edits, and postpay data-mining concepts across laboratory and genetic testing
Present rule logic and strategy to payer clients; translate complex genetic testing concepts into clear clinical narratives and financial impact/savings opportunity

Requirements

What you’ll need

Master’s degree in Genetic Counseling or related field
Board certification preferred (ABGC or equivalent)
6-8+ years in genetic counseling, molecular diagnostics, and/or laboratory utilization management
Deep knowledge of CPT/HCPCS coding for lab/genetic testing, including NGS panel billing complexity and common billing patterns
Knowledge of prior authorization and utilization management frameworks as applied to genetic testing and laboratory services

Benefits

Comp & perks

Health insurance
Dental insurance
Vision insurance
Disability insurance
Life insurance coverage
401(k) savings plans
Paid family leave
9 paid holidays per year
17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

molecular diagnosticsnext-generation sequencingmultigene panelsCPT codingHCPCS codingPLA codesCoding Validation editsdata-mining conceptsbilling practicesprior authorization

Soft Skills

clinical partnershipcommunicationpresentation skillstranslating complex conceptsstrategic thinking

Certifications

Master’s degree in Genetic CounselingBoard certification (ABGC or equivalent)