Payment Integrity Specialist

GeneDx

Payment Integrity Specialist ensuring accurate reimbursement and regulatory compliance for GeneDx. Monitoring audits and collaborating with teams to optimize revenue integrity.

Posted 7/9/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $70,000 - $86,000 per yearWebsite

About the role

Key responsibilities & impact

Monitor internal and external audits related to claims, payments, and refunds
Conduct periodic audits of payer contracts and payment activity to ensure compliance with MFN laws and contractual terms
Identify and escalate discrepancies in payment rates, coding, and authorization processes
Review and process refund requests from payers and patients
Ensure timely and accurate posting of payments and resolution of denials
Maintain detailed records of transactions and audit findings
Validate that payments align with negotiated payer contracts and MFN provisions
Collaborate with legal and contracting teams to interpret and apply MFN rules
Support payer configuration reviews and contract audits
Stay current on federal and state regulations impacting payment integrity, including MFN laws
Ensure audit processes and documentation meet compliance standards
Assist in preparing responses to regulatory inquiries and payer audits
Partner with appeals, credentialing, and market access teams to resolve payment issues
Provide feedback and process improvement recommendations to operational teams
Participate in payer meetings and internal workgroups to enhance audit and payment workflows

Requirements

What you’ll need

Bachelor’s degree in healthcare administration, finance, or related field (or equivalent experience)
3–5 years of experience in medical billing, payment integrity, or payer contract auditing
Strong understanding of MFN laws, payer policies, and healthcare reimbursement models
Proficiency in claims management systems and data analytics tools
Exceptional attention to detail, analytical thinking, and problem-solving skills
Excellent communication and documentation abilities
CPCS or similar certification preferred

Benefits

Comp & perks

Competitive compensation and benefits
Health insurance
Paid time off
Flexible work arrangements
Professional development opportunities

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

Payment AuditingContract ComplianceClaims ProcessingRefund ManagementDiscrepancy Identification

Soft Skills

Attention to DetailAnalytical ThinkingProblem-SolvingCommunicationDocumentation

Certifications

CPCS