Appeals Specialist

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GeneDx

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

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.

📋 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 billing system. • Monitor and follow up on submitted appeals to ensure timely resolution. • Apply healthcare regulations, payor policies, and coding guidelines to maintain compliance in the appeals process. • Identify and analyze denial trends, recommending process improvements to reduce future denials. • Research payor-specific appeal processes to ensure proper steps are followed. • Collaborate with clinical teams, market access and insurances representatives to resolve appeals issues.

🎯 Requirements

• 3-5 years of experience in laboratory billing appeals. • Strong understanding of insurance policies, healthcare regulations, medical terminology, and coding. • Expertise in appeals process for major insurance plans, Medicaid, and Managed Medicaid. • Ability to manage multiple tasks and prioritize effectively. • Knowledge of industry regulations, including HIPAA. • 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 support EST hours.

🏖️ Benefits

• Paid Time Off (PTO) • Health, Dental, Vision and Life insurance • 401k Retirement Savings Plan • Employee Stock Purchase Plan • Employee Discounts • Voluntary benefits • Programs for parents and parents-to-be