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GeneDx · 21 hours ago

Claims Specialist

United States

Full-time

Onsite

Entry, Mid Level

$34/hr - $37/hr

2+ years exp

GeneDx is a leader in genomic testing and interpretation services, dedicated to transforming healthcare through precision medicine. The Claims Specialist is responsible for managing the end-to-end claims process for diagnostic laboratory services, ensuring timely and accurate submission, follow-up, and resolution of insurance claims.

AnalyticsArtificial Intelligence (AI)Health CareHealth DiagnosticsMachine LearningMedicalPredictive Analytics

Responsibilities

Claims Submission: Prepare, review, and submit claims for diagnostic lab services to commercial and government payers, ensuring compliance with payer guidelines and laboratory policies

Denial Management: Analyze denied claims, identify root causes, and initiate corrective actions including appeals and resubmissions

Follow-Up: Proactively follow up on outstanding claims, monitor aging reports, and communicate with payers to resolve issues and expedite payment

Documentation: Maintain accurate records of claim status, correspondence, and payer responses in the billing system

Collaboration: Work closely with prior authorization, billing, and reimbursement teams to resolve complex claims and support cross-functional RCM initiatives

Compliance: Stay current with payer requirements, coding updates (CPT, ICD-10), and regulatory changes affecting laboratory claims

Reporting: Generate and analyze claims performance reports to identify trends, opportunities for process improvement, and support management decision-making

Qualification

Medical claims processingInsurance billing knowledgeLaboratory coding CPTLaboratory coding ICD-10Billing software proficiencyMicrosoft Office SuiteAttention to detailOrganizational skillsCommunication skillsWork independentlyCollaborative skills