[Hiring] Appeals Specialist @GeneDx

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 the 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 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.

Work Environment

This is a fully remote position. The employee will work from a home office or other suitable remote location with reliable high-speed internet access. Work is performed in a climate-controlled environment using standard office equipment including computer, phone, and video conferencing tools. Your standard work schedule and hours will be established in collaboration with your leader and may be adjusted to align with evolving business needs.

Physical Demands

• Sitting for extended periods (up to 8 hours per day).
• Repetitive use of hands and fingers for typing and mouse operation.
• Visual acuity for reading computer screens and documents.
• Ability to communicate effectively via phone and video calls.
• Occasional lifting of up to 10 pounds (office supplies, equipment).

Acknowledgements

The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.

Pay Transparency, Budgeted Range

$31.25 — $33.65 USD

Company Description

At GeneDx, we're driven by urgency and purpose: helping patients get diagnosed earlier. Our mission, to empower everyone to live their healthiest life through genomics, drives our team to make a tangible impact each day – and shapes our culture where high standards, strong teamwork, and meaningful ownership are the norm.

• Play like a champion (step up, redefine what’s possible, own it).
• Think bigger (stretch beyond, courage not consensus).
• Grow fast (be curious, speak up, be agile).

If you’re motivated by meaningful work, a fast-moving environment, and teammates who care deeply about outcomes, you’ll thrive at GeneDx.

At GeneDx, we believe in taking care of our people. We provide competitive compensation and benefits that reflect local market practices and legal requirements in each country where we operate, helping employees thrive both professionally and personally.

We welcome everyone regardless of their background. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, gender, gender identity, sexual orientation, protected veteran status, disability, age, and other characteristics protected by law.

GeneDx is a place where people from all backgrounds can make an impact.