Claims Specialist

November 26

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GeneDx

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At GeneDx, we believe that everyone deserves personalized, targeted medical care—and that it all begins with a genetic diagnosis. Fueled by one of the world’s largest rare disease data sets, our industry-leading exome and genome tests translate complex genomic data into clinical answers that unlock personalized health plans, accelerate drug discovery, and improve health system efficiencies. It all starts with a single test.

1001 - 5000 employees

📋 Description

• Claims Submission: Prepare, review, and submit claims for diagnostic lab services to commercial and government payers, ensuring compliance with payer guidelines and laboratory policies. • Denial Management: Analyze denied claims, identify root causes, and initiate corrective actions including appeals and resubmissions. • Follow-Up: Proactively follow up on outstanding claims, monitor aging reports, and communicate with payers to resolve issues and expedite payment. • Documentation: Maintain accurate records of claim status, correspondence, and payer responses in the billing system. • Collaboration: Work closely with prior authorization, billing, and reimbursement teams to resolve complex claims and support cross-functional RCM initiatives. • Compliance: Stay current with payer requirements, coding updates (CPT, ICD-10), and regulatory changes affecting laboratory claims. • Reporting: Generate and analyze claims performance reports to identify trends, opportunities for process improvement, and support management decision-making.

🎯 Requirements

• Associate’s or Bachelor’s degree in healthcare administration, business, or related field (preferred). • 2+ years of experience in medical claims processing, preferably in a diagnostic laboratory or healthcare setting. • Strong knowledge of insurance billing, payer requirements, and denial management. • Familiarity with laboratory coding (CPT, ICD-10), EOBs, and remittance advice. • Proficiency with billing software and Microsoft Office Suite. • Excellent attention to detail, organizational, and communication skills. • Ability to work independently and collaboratively in a fast-paced environment.

🏖️ Benefits

• Paid Time Off (PTO) • Health, Dental, Vision and Life insurance • 401k Retirement Savings Plan • Employee Discounts • Voluntary benefits