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.
Summary
The Clinical Billing Integrity team focuses on ensuring that all claims and invoices submitted to payers and other customers comply with medical necessity rules and requirements. This is a cross functional role that will collaborate at various times with claims, coding, appeals and other internal clinical teams to ensure adherence to payer policies and regulatory guidelines, mitigating the risk of claim denials and success of appeals to ensure accurate reimbursement. Day to day activities will be dependent on organizational needs and may include direct outreach to providers and members, research and support for prior authorizations, claims, and appeals, as well as documentation and data entry tasks. The Clinical Billing Integrity Billing Specialist will need to be flexible, have strong multitasking skills, and be able to quickly adjust to changing situations. They should be able to work independently and be confident in their ability to learn new tasks quickly.
Job Responsibilities
- Review and analyze claims data to identify trends in claims submissions, denials, payments, etc.
- Research payor-specific processes to ensure proper steps are followed.
- Communicate with healthcare providers and insurance representatives.
- Submit required documentation to payors and clients.
- Apply healthcare regulations, payor policies, and coding guidelines to maintain compliance.
- Collaborate with clinical teams, market access, and insurances representatives based on needs of assigned tasks.
- Perform additional responsibilities as assigned while demonstrating company leadership attributes and supporting the Mission and Values of the company.
People Manager
Education, Experience, and Skills
- 3-5 years of experience in laboratory billing involving major insurance plans, Medicaid, and Medicare.
- Strong understanding of insurance policies, healthcare regulations, medical terminology, and coding.
- 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.
#LI-REMOTE
Pay Transparency, Budgeted Range
$31.25 - $33.65 USD
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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.
