Claims Specialist

GeneDx

Claims Specialist managing claims process in diagnostic laboratory. Ensuring timely and accurate submission, follow-up, and resolution of insurance claims to maximize reimbursement.

Posted 6/4/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $34 - $37 per hourWebsite

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

Associate’s or Bachelor’s degree in healthcare administration, business, or related field (preferred).
2+ years of experience in medical claims processing, preferably in a diagnostic laboratory or healthcare setting.
Strong knowledge of insurance billing, payer requirements, and denial management.
Familiarity with laboratory coding (CPT, ICD-10), EOBs, and remittance advice.
Proficiency with billing software and Microsoft Office Suite.
Excellent attention to detail, organizational, and communication skills.
Ability to work independently and collaboratively in a fast-paced environment.

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims submissiondenial managementinsurance billinglaboratory codingCPTICD-10billing softwareclaims performance reportingprocess improvement

Soft Skills

attention to detailorganizational skillscommunication skillsindependent workcollaborative work