Appeals Specialist

Responsibilities

• Review denied claims and assess appeal potential
• Prepare and submit documented appeals for laboratory services
• Communicate with providers and insurance representatives for supporting records
• Track appeals, follow up on resolution, and maintain billing system records
• Analyze denial trends and recommend process improvements
• Apply payor policies, coding guidelines, and healthcare regulations
• Collaborate with clinical, market access, and insurance teams

Requirements

• 3-5 years of laboratory billing appeals experience
• Strong understanding of insurance policies and payor processes
• Knowledge of healthcare regulations, medical terminology, and coding
• Experience with major insurance plans, Medicaid, and Managed Medicaid
• Familiarity with HIPAA compliance
• Proficiency in Microsoft Office Suite
• Xifin experience preferred
• Ability to support EST hours

About the Company

GeneDx provides personalized health insights through exome and genome testing and interpretation services. The company focuses on genomics and large-scale clinical data to improve diagnosis and treatment.