RCM Insurance Claims Manager

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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

• Lead and manage the claims process for diagnostic laboratory services from claim submission through final resolution, ensuring timely and accurate reimbursement. • Oversee the review and resolution of denied, pending, and aging claims, ensuring thorough investigation and appropriate corrective action. • Ensure claims are submitted and managed in accordance with payer requirements, billing guidelines, and regulatory standards. • Partner with internal teams and external billing vendors to resolve complex claim issues and improve reimbursement outcomes. • Monitor claims inventory, accounts receivable performance, and operational metrics to ensure service level expectations are achieved. • Lead, coach, and develop the Claims team, setting clear performance expectations and driving accountability for productivity, quality, and reimbursement results. • Analyze claims and denial trends, identify root causes, and implement process improvements to reduce preventable denials and enhance claim performance. • Communicate effectively with payers, vendors, and internal stakeholders to resolve issues, provide updates, and support organizational objectives. • Prepare regular reports on claims activities, operational performance, reimbursement trends, and team productivity for leadership. • Coordinate system implementations, upgrades, and process improvements related to claims workflows and billing operations and oversee ongoing support and maintenance activities. • Develop and maintain claims-related policies, procedures, training materials, and operational best practices. • The job may have added responsibilities as assigned. All job duties must be performed in a manner that demonstrates the company's Leadership Attributes and supports the Mission & Values of the company.

🎯 Requirements

• Bachelor’s degree in healthcare administration, business, finance, or equivalent experience in a related field. • 5–7 years of experience in laboratory billing, insurance claims, or revenue cycle management, specifically leading claims operations preferred. • Strong understanding of insurance claim processes, healthcare regulations, HIPAA, and compliance requirements. • Strong critical thinking skills to identify root causes, resolve complex claim issues, and implement effective solutions. • Advanced knowledge of payer requirements, claim adjudication processes, denial management, and reimbursement methodologies. • Ability to think critically, work efficiently and responsibly in a collaborative environment with multiple work demands and short time frames. • Excellent leadership, communication, and organizational skills. • Ability to analyze data, identify trends, and implement operational improvements that enhance claims performance and reimbursement outcomes. • Understanding of industry-specific policies and regulations, including HIPAA requirements and payer compliance standards preferred. • Experience using Microsoft Office applications. • Familiarity with AI tools and technologies and the ability to leverage them to improve productivity, data analysis, reporting, workflow efficiency, and operational decision-making.

🏖️ Benefits

• Competitive compensation and benefits that reflect local market practices and legal requirements in each country where we operate