[Hiring] Appeals Specialist @GeneDx
Mar 26, 2025 - GeneDx is hiring a remote Appeals Specialist. 💸 Salary: $31.25 - $33.65 usd. 📍Location: USA.
Role Description
The Appeals Specialist is responsible for reviewing denied claims, identifying root causes, and submitting well-documented appeals to maximize reimbursement for specialized laboratory services. This role requires expertise in insurance and government payors, healthcare regulations, and denial resolution. The Appeals Specialist will analyze denial trends, report findings to management, and collaborate with internal teams to improve appeal success rates.
- 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.
- Perform additional responsibilities as assigned while demonstrating company leadership attributes and supporting of the Mission and Values of the company.
Qualifications
- 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.
Requirements
- Pay Transparency, Budgeted Range: $31.25 — $33.65 USD
Benefits
- Paid Time Off (PTO)
- Health, Dental, Vision and Life insurance
- 401k Retirement Savings Plan
- Employee Discounts
- Voluntary benefits
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| 📍 | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
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Salary
💸
$31.25 - $33.65 usd
|
Remote
Location
USA
|
|
Job Type
unspecified
|
Posted
Mar 26, 2025
|
| 📍 | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
