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Appeals Manager

GeneDx Inc

GeneDx Inc

Posted on Tuesday, June 11, 2024

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.
Pay Transparency, Budgeted Range
$115,000$125,000 USD


Science - Minded, Patient - Focused.

At GeneDx, we create, follow, and are informed by cutting-edge science. With over 20 years of expertise in diagnosing rare disorders and diseases, and pioneering work in the identification of new disease-causing genes, our commitment to genetic disease detection, discovery, and diagnosis is based on sound science and is focused on enhancing patient care.

Experts in what matters most.

With hundreds of genetic counselors, MD/PhD scientists, and clinical and molecular genomics specialists on staff, we are the industry’s genetic testing experts and proud of it. We share the same goal as healthcare providers, patients, and families: to provide clear, accurate, and meaningful answers we all can trust.


From sequencing to reporting and beyond, our technical and clinical experts are providing guidance every step of the way:


  • High-quality testing: Our laboratory is CLIA certified and CAP accredited and most of our tests are also New York State approved.
  • Advanced detection: By interrogating genes for complex variants, we can identify the underlying causes of conditions that may otherwise be missed.


  • Thorough analysis: We classify variants according to our custom adaptation of the most recent guidelines. We then leverage our rich internal database for additional interpretation evidence.
  • Customized care: Our experts review all test results and write reports in a clear, concise, and personalized way. We also include information for research studies in specific clinical situations.
  • Impactful discovery: Our researchers continue working to find answers even after testing is complete. Through both internal research efforts and global collaborations, we have identified and published hundreds of new disease-gene relationships and developed novel tools for genomic data analysis. These efforts ultimately deliver more diagnostic findings to individuals.

Learn more About Us here.


Benefits include:

  • Paid Time Off (PTO)
  • Health, Dental, Vision and Life insurance
  • 401k Retirement Savings Plan
  • Employee Discounts
  • Voluntary benefits

GeneDx is an Equal Opportunity Employer.

All privacy policy information can be found here.