Payor Credentialing Specialist

Summary

The Payer Credentialing Specialist at GeneDx plays a pivotal role in ensuring the company receives appropriate reimbursement for services by managing timely and precise payer enrollment, reenrollment, and credentialing processes. This position is vital for maintaining compliance with regulatory standards and establishing relationships with commercial and government payers. 

Job Responsibilities

• Under the supervision of the Payer Enrollment and Credentialing Manager, execute the credentialing of in-network and out-of-network commercial and government payers, achieve and maintain PECOS certification, handle enrollment processes in line with state and federal regulations, and proactively address and resolve issues, proposing actionable solutions. 

• Conduct follow-up with regulatory agencies and payers as necessary. 

• Handle requests for payer roster assessments, ensuring accurate and up-to-date listings within payer networks. 

• Collaborate with the Finance Department to establish single case agreements. 

• Manage the setup and maintenance of EDI/EFT accounts to ensure payment accuracy. 

• Oversee payer portal updates and access for both internal and external stakeholders.  

• Oversee all aspects of payer communication, updates, and management, excluding contract negotiations. This includes maintaining relationships with various payers, staying updated on payer requirements, and ensuring regulatory compliance, all on an ongoing and ad hoc basis. 

• Maintain all necessary documentation for credentialing and enrollment processes and procedures.  

• Build a collaborative relationship with internal/external staff. 

• Assume additional responsibilities as needed within the department beyond the primary duties listed. 

Education, Experience, and Skills

• A college or university degree is preferred. However, relevant experience can be accepted instead of a degree. 

• 2-3 years’ experience in healthcare roles with emphasis in credentialing and enrollments, payer policy, or contracting with payer organizations. 

• Able to handle multiple priorities and consistently meet deadlines.  

• Ability to identify issues or gaps in processes, problem-solve, gather feedback and implement solutions. 

• Strong technical skills – Microsoft Excel, Word, etc.  

• Ability to handle sensitive and confidential information appropriately. 

Work Environment 

 This role is remote. The employee will work from a home office or other suitable remote location with reliable high-speed internet access. Work is performed in a climate-controlled environment using standard office equipment including computer, phone, and video conferencing tools. Your standard work schedule and hours will be established in collaboration with your leader and may be adjusted to align with evolving business needs. 

Physical Demands 

This is a sedentary role requiring prolonged periods of sitting while working at a computer. Physical demands include: 

• Sitting 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 

• Ability to communicate effectively via phone and video calls 

• Occasional lifting of up to 10 pounds (office supplies, equipment) 

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position. 

Acknowledgements

The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.

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Pay Transparency, Budgeted Range
$30.25—$37.50 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.