Claims Specialist

GeneDx•Gaithersburg, MD

1d•$34 - $37•Remote

About The Position

GeneDx (Nasdaq: WGS) delivers personalized and actionable health insights to inform diagnosis, direct treatment, and improve drug discovery. The company is uniquely positioned to accelerate the use of genomic and large-scale clinical information to enable precision medicine as the standard of care. GeneDx is at the forefront of transforming healthcare through its industry-leading exome and genome testing and interpretation services, fueled by the world’s largest, rare disease data sets. For more information, please visit www.genedx.com . Summary The Claims Specialist is responsible for managing the end-to-end claims process for diagnostic laboratory services, ensuring timely and accurate submission, follow-up, and resolution of insurance claims. This role is critical to maximizing reimbursement, reducing denials, and supporting the financial health of the laboratory.

Requirements

Associate’s or Bachelor’s degree in healthcare administration, business, or related field (preferred).
2+ years of experience in medical claims processing, preferably in a diagnostic laboratory or healthcare setting.
Strong knowledge of insurance billing, payer requirements, and denial management.
Familiarity with laboratory coding (CPT, ICD-10), EOBs, and remittance advice.
Proficiency with billing software and Microsoft Office Suite.
Excellent attention to detail, organizational, and communication skills.
Ability to work independently and collaboratively in a fast-paced environment.

Responsibilities

Claims Submission: Prepare, review, and submit claims for diagnostic lab services to commercial and government payers, ensuring compliance with payer guidelines and laboratory policies.
Denial Management: Analyze denied claims, identify root causes, and initiate corrective actions including appeals and resubmissions.
Follow-Up: Proactively follow up on outstanding claims, monitor aging reports, and communicate with payers to resolve issues and expedite payment.
Documentation: Maintain accurate records of claim status, correspondence, and payer responses in the billing system.
Collaboration: Work closely with prior authorization, billing, and reimbursement teams to resolve complex claims and support cross-functional RCM initiatives.
Compliance: Stay current with payer requirements, coding updates (CPT, ICD-10), and regulatory changes affecting laboratory claims.
Reporting: Generate and analyze claims performance reports to identify trends, opportunities for process improvement, and support management decision-making.