Product Owner, Coverage and Claims Automation

GeneDx; United States; Remote; USD 127,000 - 160,000; Full time

Job summary

GeneDx is looking for a Product Owner to enhance automated coverage and prior authorization workflows. The successful candidate will partner with various departments to streamline operations and improve key performance metrics, contributing to an innovative healthcare environment focused on genetic disease diagnosis.

Benefits

Paid Time Off (PTO)

Health, Dental, Vision and Life insurance

401k Retirement Savings Plan

Employee Discounts

Voluntary benefits

Qualifications

• 2–5 years product-ownership / product-management experience in revenue cycle.
• Deep understanding of coverage verification and PA workflows.
• Fluent in agile delivery and product discovery practices.

Responsibilities

• Prioritize product backlogs for automation and claims workflows.
• Lead cross-functional discovery for high-impact opportunities.
• Define and track KPIs for PA and claims processes.

Skills

Analytical

Communicative

Execution-focused

Education

Bachelor’s degree

Revenue-cycle certification (e.g., CRCR)

Job description

Summary

GeneDx is seeking a Product Owner to drive the strategy and day-to-day execution of automated coverage, prior authorization (PA), and claim workflows. Partnering with Engineering on our Billing Service integrations and PA API—and collaborating with Billing and RCM Operations—you will streamline the entire order-to-cash journey.

What success looks like: PA approvals rise, first-pass claim resolution climbs, denial rates fall, and manual touches shrink—freeing RCM teams to focus on true exceptions and accelerating cash collection.

Job Responsibilities

• Prioritize and groom product backlogs for coverage verification, PA automation, claim-rules engine, denial prevention, and auto-appeals.

• Lead cross-functional discovery with Billing Ops, RCM, Finance, Client Services, Compliance, and Engineering to surface, size, and sequence high-impact automation opportunities.

• Translate requirements into detailed user stories covering coverage rules, PA submission flows, claim scrubber logic, and status visibility; validate delivery against acceptance criteria.

• Coordinate vendor integrations to ensure data integrity, timely error handling, and scalable architecture.

• Define and maintain RCM dashboards (FRRR, PA cycle time, denial root-cause) with Analytics; iterate based on insights.

• Own the payer-policy rule library and drive swift updates when payer requirements change.

• Facilitate agile ceremonies as needed—backlog refinement, sprint planning, demos, retrospectives—to keep squads aligned and blockers removed.

• Produce artifacts such as PRDs, coverage-logic maps, data-flow diagrams, UAT scripts, KPI reports, and release notes.

• Define and track KPIs such as:
• Increase prior-authorization approval percentage
• Decrease PA turnaround time
• Increase First-Pass Resolution Rate (FRRR)
• Increase auto-appeal success rate
• Decrease manual claim touches per order
• Decrease overall denial rate

Education, Experience, and Skills

• 2–5 years product-ownership / product-management experience in revenue cycle, payer policy, or healthcare operations technology.
• Deep understanding of coverage verification, PA workflows, and medical claims (EDI 837/835, denial codes, appeal cycles).
• Demonstrated systems thinking—mapping complex workflows across billing systems, vendor integrations, payer interactions, and RCM operational processes.
• Analytical, communicative, and execution-focused: skilled at defining KPIs, building dashboards, and turning insights into backlog priorities.
• Familiarity with HIPAA, EDI standards, and regulatory impacts on claims processing.
• Comfortable collaborating with platform engineers, vendor integrators, and RCM Operations teams; adept at translating business rules into technical requirements.
• Fluent in agile delivery and modern product discovery practices.
• Bachelor’s degree required; advanced degree or revenue-cycle certification (e.g., CRCR) a plus.

#LI-REMOTE

Pay Transparency, Budgeted Range

$127,545—$159,431 USD

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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.

SEQUENCING HAS THE POWER TO SOLVE DIAGNOSTIC CHALLENGES.

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

TECHNICAL EXPERTISE

• 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.

CLINICAL EXPERTISE

• 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.

Our Culture

At GeneDx, we are dedicated to cultivating an environment where creativity and innovation thrive. We believe in the power of community and collaboration, where diverse perspectives are embraced, and every voice contributes to our shared success. Our team is a vibrant mix of professionals who challenge and support each other in equal measure, fostering growth both personally and professionally. When you join us, you're not just taking on a job—you're joining a movement. A movement that champions curiosity, embraces change, and believes in making an impact, one patient at a time. Cultural principles we live by:

• Be bold in our vision & brave in our execution.
• Communicate directly, with empathy.
• Do what we say we're going to do.
• Be adaptable to change.
• Operate with a bias for action.

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.