Appeals Specialist

GeneDx

Appeals Specialist performing claim reviews and appeals at GeneDx. Engaging with healthcare providers to ensure documentation and reimbursement for laboratory services.

Posted 7/9/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $31 - $34 per hourWebsite

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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.

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 Review and AnalysisAppeal Documentation ManagementDenial Trend AnalysisCoding Guidelines ApplicationPayor Policies Understanding

Soft Skills

Attention to DetailOrganizational AbilitiesEffective PrioritizationCommunication Skills