RCM Insurance Claims Manager

Responsibilities

• Lead and manage the claims process for diagnostic laboratory services from submission through final resolution
• Oversee the review and resolution of denied, pending, and aging claims
• Ensure claims compliance with payer requirements, billing guidelines, and regulatory standards
• Partner with internal teams and external billing vendors to resolve complex claim issues
• Monitor claims inventory, accounts receivable performance, and operational metrics
• Lead, coach, and develop the Claims team to drive productivity and quality
• Analyze claims and denial trends to implement process improvements
• Prepare regular reports on claims activities and reimbursement trends for leadership
• Coordinate system implementations and upgrades related to billing operations
• Develop and maintain claims-related policies, procedures, and training materials

Requirements

• Bachelor’s degree in healthcare administration, business, finance, or equivalent experience
• 5–7 years of experience in laboratory billing, insurance claims, or revenue cycle management
• Strong understanding of insurance claim processes, healthcare regulations, and HIPAA
• Advanced knowledge of payer requirements and denial management
• Excellent leadership, communication, and organizational skills
• Proficiency with Microsoft Office applications
• Familiarity with AI tools to improve workflow efficiency

About the Company

At GeneDx, we're driven by urgency and purpose: helping patients get diagnosed earlier. Our mission, to empower everyone to live their healthiest life through genomics, drives our team to make a tangible impact each day.