Note: The job is a remote job and is open to candidates in USA. Physicians Group Laboratories is preparing to launch a phased pharmacogenomics testing program. The Consultant will provide strategic advisory oversight on PGx requisition development, reimbursement, prior authorization, billing and LIS integration, training, pilot evaluation, risk mitigation, and launch readiness.
Responsibilities
- Billing infrastructure & LIS integration. Review scoping, build plans, and validation testing for the LIS-to-billing integration so claims can push through for automated billing before any live ordering at scale
- Requisition development. Guide the build of the custom PGx requisition — comprehensive drug lists and gene selection(typically 9–11 pages), ICD-10 diagnosis-to-drug mapping, and actionable/cautionary/do-not-use (A-C-D) provider categories — and review v1.0 before clinical, billing, and compliance sign-off. Advise on the maintenance process for ongoing FDA and CPIC guidance updates
- Payer strategy & prior authorization. Guide development of the payer-by-payer coverage matrix, LCD criteria documentation, and compliance standards. Review provider-facing prior-auth guidance before any clinic is onboarded
- RCM readiness. Advise on the hiring profile, training, and ramp plan for a dedicated PGx RCM specialist, and review pre-auth workflows, denial management, and appeals processes
- Training curriculum review. Review the PGx sales training curriculum (science fundamentals, report interpretation, panel selection, pre-auth expectations, competitive positioning) and cross-functional training plans for CX, lab, and provider audiences
- Pilot oversight & launch readiness. Review pilot findings, denial trends, and turnaround-time benchmarks; recommend corrective actions; and contribute to the formal Go/No-Go readiness assessment for full launch
- Risk mitigation. Counsel leadership on the program's known risks — documentation-driven denials, turnaround-time competitiveness, and provider expectation management — with practical mitigation strategies
Skills
- 7+ years in the clinical laboratory industry, including 3+ years focused on pharmacogenomics testing programs
- Hands-on experience launching or operating a PGx testing program at a clinical laboratory
- Deep expertise in PGx reimbursement: payer coverage policy, LCD/MolDX criteria, prior authorization workflows, ICD-10 coding for PGx, and denial management
- Working knowledge of CPIC guidelines and FDA pharmacogenomic labeling, including how ongoing updates drive requisition and panel maintenance
- Experience with LIS and billing system integrations in a clinical lab environment
- Proven ability to advise executives and cross-functional teams, with strong document review and written communication skills
- Advanced credential such as PharmD, PhD (genetics/pharmacology), MB(ASCP), or certified professional coder with molecular diagnostics experience
- Experience positioning a lab against established PGx competitors on turnaround time, reporting, and service model
- Experience developing sales training or provider education for genetic or molecular testing
Benefits
- Fully remote consulting engagement
- Flexible weekly hours that scale with each launch phase
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