Appeals Specialist

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $31 - $33 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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GeneDx

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🧬 Biotechnology

🏥 Healthcare

🤖 Artificial Intelligence

Biotechnology • Healthcare • Artificial Intelligence

GeneDx is a biotechnology company dedicated to providing personalized and targeted medical care through genetic diagnosis. Leveraging one of the largest datasets for rare diseases, GeneDx offers advanced testing such as whole genome and exome sequencing. Their diagnostic solutions translate complex genomic information into actionable insights, facilitating personalized health plans, enhancing drug discovery, and improving the efficiency of healthcare systems.

📋 Description

• Review and analyze denied claims to determine the basis for denial and assess appeal potential • Communicate with healthcare providers and insurance representatives to gather necessary documentation for appeals • Ensure all payor-required documentation is submitted with each appeal and tracked in the billing system • Monitor and follow up on submitted appeals to ensure timely resolution • Apply healthcare regulations, payor policies, and coding guidelines to maintain compliance • Identify and analyze denial trends and recommend process improvements to reduce future denials • Research payor-specific appeal processes to ensure proper steps are followed • Collaborate with clinical teams, market access, and insurance representatives to resolve appeal issues • Perform additional responsibilities as assigned and support GeneDx’s mission and values • Report findings to management and collaborate with internal teams to improve appeal success rates

🎯 Requirements

• 3-5 years of experience in laboratory billing appeals • Strong understanding of insurance policies, healthcare regulations, medical terminology, and coding • Expertise in appeals processes for major insurance plans, Medicaid, and Managed Medicaid • Knowledge of industry regulations, including HIPAA • Ability to support EST hours • Experience with Xifin is a plus • Exceptional attention to detail and organizational abilities • Proficiency in Microsoft Office Suite (Excel, Word, Outlook, and Teams) for reporting and documentation • Ability to manage multiple tasks and prioritize effectively • Reliable high-speed internet access • Ability to communicate effectively via phone and video calls • Ability to sit for extended periods, up to 8 hours per day • Repetitive use of hands and fingers for typing and mouse operation • Visual acuity for reading computer screens and documents • Occasional lifting of up to 10 pounds

🏖️ Benefits

• Competitive compensation and benefits reflecting local market practices and legal requirements in each country where GeneDx operates • Reasonable accommodations for individuals with disabilities