Diagnostics Claims Manager - Revenue Cycle Leader

GeneDx; United States; Remote; USD 113,000 - 136,000; Full time

Job summary

GeneDx is hiring a Claims Manager to oversee the end-to-end claims process for diagnostic laboratory services. The role involves optimizing denial management, AR performance, and workflow efficiency while collaborating with billing vendors and internal teams to maximize reimbursement.

The ideal candidate has 5–7 years in claims operations, a Bachelor’s in a related field, and strong leadership and communication skills, with familiarity in HIPAA and payer requirements.

Qualifications

• Bachelor’s degree in healthcare administration, business, finance or related field.
• 5–7 years leading claims operations or revenue cycle management in a laboratory setting preferred.
• Strong knowledge of HIPAA, payer requirements and regulatory standards.
• Experience using AI tools to improve productivity, data analysis and reporting.
• Excellent leadership, communication and organizational skills.

Responsibilities

• Lead and manage the claims process from submission to final resolution for diagnostic laboratory services.
• Oversee denial, pending and aging claims to ensure timely investigation and corrective action.
• Ensure compliance with payer guidelines and regulatory standards in all claim activities.
• Collaborate with internal teams and external vendors to resolve complex claim issues.
• Monitor AR performance and operational metrics to achieve service levels.
• Coach and develop the Claims team to improve productivity and reimbursement results.
• Analyze denial trends to identify root causes and implement process improvements.
• Communicate with payers, vendors and stakeholders to resolve issues and report on activities.
• Prepare reports on claims activity, performance and reimbursement trends for leadership.

Skills

Leadership

Communication

Analytical thinking

Data analysis

Problem solving

Team building

Education

Bachelor’s degree in healthcare administration, business, finance

Tools

Microsoft Office

AI tools

Job description

GeneDx is hiring a Claims Manager to oversee the end-to-end claims process for diagnostic laboratory services. The role involves optimizing denial management, AR performance, and workflow efficiency while collaborating with billing vendors and internal teams to maximize reimbursement.

The ideal candidate has 5–7 years in claims operations, a Bachelor’s in a related field, and strong leadership and communication skills, with familiarity in HIPAA and payer requirements.