GeneDx is a patient-centric health information company that delivers personalized and actionable health insights that inform diagnosis, guide treatment and improve drug discovery. The company is transforming healthcare through its industry-leading exome and genome testing and interpretation, fueled by one of the world’s largest, rare disease data sets. GeneDx is uniquely positioned to accelerate the use of genomic and large-scale clinical information to enable precision medicine as the standard of care.

The Appeals Manager is responsible for overseeing the process of appeals for insurance claims that have been denied or require further review. This role involves managing the appeals process, working directly with billing vendor, Medical Affairs, Market Access, and various departments to develop effective appeals process aligned with payer requirements.

Job Responsibilities

• Lead and manage the claims appeals process.
• Oversee the review of denied claims, ensuring through investigation and documentation.
• Ensure appeals are filed in accordance with payer requirements.
• Collaborate with Medical Affairs and Market Access for letters of medical necessity.
• Partner with billing vendor to drive performance and training support.
• Identify and implement process improvements to enhance efficiency and accuracy in the appeals process.
• Communicate effectively with providers and internal stakeholders to provide updates on appeal status and resolve any issues.
• Analyze appeal trends and outcomes, identify patterns, improve processes, and report findings to Head of Billing.
• Prepare regular reports on appeal activities outcomes, and team performance for senior leadership.
• Coordinate systems implementation upgrades and improvements in our billing and financial systems and oversee the support and maintenance for appeals documentation.
• The job may have added responsibilities as assigned. All job duties must be performed in a manner that demonstrates the company Leadership Attributes and support of the Mission & Values of the company.

Ideal Candidate

• 5-7 years of managerial experience in laboratory and insurance billing, specifically leading appeals process.
• Strong understanding of insurance claim processes, healthcare regulations, HIPAA, and compliance.
• Strong critical thinking skills to address challenges and filed effective solutions.
• Advanced knowledge of payer requirements.
• Ability to think critically, work efficiently and responsibly in a collaborative environment with multiple work demands and brief time frames.
• Experience in billing for genetic testing with Tier 1 and Tier 2 Molecular Pathology codes.
• Excellent leadership, communication, and organizational skills.
• Ability to analyze data, identify trends and implement improvements.
• XiFin experience a plus
• Understanding of industry-specific policies, such as HIPAA regulations for health care.
• Experience using Google Apps, Mac OS X, and CRM applications (i.e., Salesforce) XiFin and careviso.