Associate Director, Denials and Appeals

GeneDx (Nasdaq: WGS) delivers personalized and actionable health insights to inform diagnosis, direct treatment, and improve drug discovery. The company is uniquely positioned to accelerate the use of genomic and large-scale clinical information to enable precision medicine as the standard of care. GeneDx is at the forefront of transforming healthcare through its industry-leading exome and genome testing and interpretation services, fueled by the world’s largest, rare disease data sets. For more information, please visit www.genedx.com.

Summary

The Associate Director, Claims and Denials is responsible for leading and optimizing the claims follow-up and denials management functions within the revenue cycle. This role ensures timely resolution of outstanding claims, reduces denial rates, and strengthens payer relationships to improve reimbursement outcomes. The ideal candidate brings 5–10 years of hands-on experience in medical billing, with a strong background in payer interactions and denial mitigation strategies.

Job Responsibilities

• Lead and manage the claims follow-up and denials team, ensuring productivity and quality standards are met.
• Develop and implement strategies to reduce denials and improve first-pass claim resolution rates.
• Analyze denial trends and collaborate with internal departments to address root causes.
• Serve as a primary liaison with payers to resolve complex claim issues and negotiate resolutions.
• Monitor KPIs related to claims aging, denial rates, and recovery performance; report findings to senior leadership.
• Oversee the development of training programs to enhance team expertise in payer guidelines and denial management.
• Collaborate with compliance and coding teams to ensure accurate claim submissions and adherence to regulatory requirements.
• Support system upgrades and automation initiatives to streamline claims and denials workflows.

 People Manager

• Yes
• Lead and manage the Denials and Appeals teams, ensuring daily operations are executed with accuracy, timeliness, and compliance.
• Serve as the primary point of contact for direct reports, conducting regular check-ins to address concerns, monitor performance, and provide coaching.
• Oversee staffing levels and scheduling to ensure adequate coverage for high-volume remittance and correspondence workflows.
• Set clear performance goals and expectations for team members, aligned with revenue cycle KPIs such as timely filing of claims and appeals.
• Develop and maintain SOPs for appeals and denials workflows, ensuring alignment with industry best practices and internal audit requirements.
• Support automation initiatives and system enhancements to reduce manual work and improve efficiency.
• Ensure compliance with HIPAA, payer guidelines, and internal policies.

 Education, Experience, and Skills 

• Bachelor’s degree in Healthcare Administration, Accounting, Business, or related field or commensurate experience.
• 5–10 years of experience in medical billing, denials and appeals, preferably in a laboratory or genetic testing environment.
• Strong understanding of remittance processing, EOB/ERA interpretation, and appeals practices.
• Proven leadership experience with the ability to manage and develop high-performing teams.
• Excellent attention to detail, analytical skills, and problem-solving abilities.
• Proficiency in billing systems, clearinghouses, and financial reporting tools.

Certificates, Licenses, Registrations

• N/A

Physical Demands

• Ability to sit for long periods of time.
• Computer work including email, data analytics and online meetings.

Work Environment

• Remote position.
• Standard work hours are Monday through Friday, 9 AM to 5 PM EST
• Potential travel for in-person meetings.

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