Appeals Specialist
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AI Summary
GeneDx (Nasdaq: WGS) delivers personalized and actionable health insights to inform diagnosis, direct treatment, and improve drug discovery. The company is uniquely positioned to accelerate the use of genomic and large-scale clinical information to enable precision medicine as the standard of care. GeneDx is at the forefront of transforming healthcare through its industry-leading exome and genome testing and interpretation services, fueled by the world’s largest, rare disease data sets. For more information, please visit www.genedx.com.
The Appeals Specialist is responsible for reviewing denied claims, identifying root causes, and submitting well-documented appeals to maximize reimbursement for specialized laboratory services. This role requires expertise in insurance and government payors, healthcare regulations, and denial resolution. The Appeals Specialist will analyze denial trends, report findings to management, and collaborate with internal teams to improve appeal success rates.
Job Responsibilities
- 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.
- Perform additional responsibilities as assigned while demonstrating company leadership attributes and supporting of the Mission and Values of the company.
Ideal Candidate
- 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.
#LI-REMOTE
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Science - Minded, Patient - Focused.
At GeneDx, we create, follow, and are informed by cutting-edge science. With over 20 years of expertise in diagnosing rare disorders and diseases, and pioneering work in the identification of new disease-causing genes, our commitment to genetic disease detection, discovery, and diagnosis is based on sound science and is focused on enhancing patient care.
Experts in what matters most.
With hundreds of genetic counselors, MD/PhD scientists, and clinical and molecular genomics specialists on staff, we are the industry’s genetic testing experts and proud of it. We share the same goal as healthcare providers, patients, and families: to provide clear, accurate, and meaningful answers we all can trust.
SEQUENCING HAS THE POWER TO SOLVE DIAGNOSTIC CHALLENGES.
From sequencing to reporting and beyond, our technical and clinical experts are providing guidance every step of the way:
TECHNICAL EXPERTISE
- High-quality testing: Our laboratory is CLIA certified and CAP accredited and most of our tests are also New York State approved.
- Advanced detection: By interrogating genes for complex variants, we can identify the underlying causes of conditions that may otherwise be missed.
CLINICAL EXPERTISE
- Thorough analysis: We classify variants according to our custom adaptation of the most recent guidelines. We then leverage our rich internal database for additional interpretation evidence.
- Customized care: Our experts review all test results and write reports in a clear, concise, and personalized way. We also include information for research studies in specific clinical situations.
- Impactful discovery: Our researchers continue working to find answers even after testing is complete. Through both internal research efforts and global collaborations, we have identified and published hundreds of new disease-gene relationships and developed novel tools for genomic data analysis. These efforts ultimately deliver more diagnostic findings to individuals.
Learn more About Us here.
A culture that plays to win, because patients are counting on us
At GeneDx, we're driven by urgency and purpose: helping patients get diagnosed earlier. Our mission, to empower everyone to live their healthiest life through genomics, drives our team to make a tangible impact each day – and shapes our culture where high standards, strong teamwork, and meaningful ownership are the norm. We act with intention, support one another, and deliver work we're proud to put our names on.
Here’s what you can expect day to day:
1. Play like a champion (step up, redefine what’s possible, own it)
We bring energy, focus, and a bias for action. We step up, take initiative, and deliver on our commitments – with quality, speed, and care.
We push past the obvious. We challenge assumptions, raise the bar, and make thoughtful, decisive calls — choosing progress over perfection.
We stay curious, ask questions, and share direct feedback with respect. We adapt quickly and keep learning through collaboration and continuous improvement.
If you’re motivated by meaningful work, a fast-moving environment, and teammates who care deeply about outcomes, you’ll thrive at GeneDx.
Benefits include:
- 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
- We provide expert support for family planning, pregnancy, and postpartum care, including up to 22 weeks of fully paid parental leave (U.S.) and up to $25K annually for fertility, adoption, or surrogacy.
GeneDx is an Equal Opportunity Employer.
All privacy policy information can be found here.
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