Appeals Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluate and investigate denied claims to ascertain the reasons for denial and assess the potential for appeal.

• Engage with healthcare providers and insurance representatives to collect necessary documentation for appeals.

• Ensure that all documentation required by payors is submitted with each appeal and properly tracked in the billing system.

• Monitor and follow up on submitted appeals to guarantee timely resolutions.

• Apply healthcare regulations, payor policies, and coding guidelines to ensure compliance.

• Identify and analyze trends in denials and suggest process improvements to mitigate future denials.

• Research specific appeal processes for different payors to ensure adherence to the correct procedures.

• Collaborate with clinical teams, market access, and insurance representatives to address appeal-related issues.

• Undertake additional responsibilities as assigned and support GeneDx’s mission and values.

• Report findings to management and work with internal teams to enhance appeal success rates.

⛳️ Requirements

• 3-5 years of experience in laboratory billing appeals.

• Strong understanding of insurance policies, healthcare regulations, medical terminology, and coding.

• Expertise in appeals processes for major insurance plans, Medicaid, and Managed Medicaid.

• Knowledge of industry regulations, including HIPAA.

• Ability to support EST hours.

• Experience with Xifin is a plus.

• Exceptional attention to detail and strong organizational skills.

• Proficiency in Microsoft Office Suite (Excel, Word, Outlook, and Teams) for reporting and documentation purposes.

• Ability to manage multiple tasks and prioritize effectively.

• Reliable high-speed internet access.

• Effective communication skills via phone and video calls.

• Ability to sit 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.

• Occasional lifting of up to 10 pounds.

🏝️ Benefits

• Competitive compensation and benefits that reflect local market practices and legal requirements in each country where GeneDx operates.

• Reasonable accommodations for individuals with disabilities.