Manager – Provider Credentialing @ GeneDx

Operations & Logistics (3)
, ,

Operations & Logistics (3)

, ,

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 Manager of Payer Enrollment and Credentialing 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

Manages the credentialing of in-network and out-of-network commercial and government payers, achieves and maintains PECOS certification, handles enrollment processes in line with state and federal regulations, and proactively addresses and resolves issues, proposing actionable solutions.
Handles requests for payer roster assessments, ensuring accurate and up-to-date listings within payer networks.
Collaborates with the Finance Department to establish single case agreements.
Negotiate vendor agreements for non-payers, such as State Departments.
Manage the setup and maintenance of EDI/EFT accounts to ensure payment accuracy.
Oversees payer portal updates and access for both internal and external stakeholders.
Collaborates with the Market Access team to ensure provider enrollment and credentialing processes are aligned with payer requirements and contracts.
Oversees 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.
Prepares and delivers internal educational materials to inform internal stakeholders about credentialing activities and complexities, including bringing others in when necessary.
Assumes additional responsibilities as needed within the department beyond the primary duties listed.

People Manager

Yes, leads a small team of credentialing specialists

Education, Experience, and Skills

5-7 years’ experience in healthcare roles with emphasis in credentialing and enrollments, payer policy, or contracting with payer organizations.
Minimum of 1 year in a leadership or supervisory position.
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.
A college or university degree is preferred. However, relevant experience can be accepted instead of a degree.
CPCS certification or candidate for certification is preferred.

#LI-REMOTE

Pay Transparency, Budgeted Range

$120,000—$140,000 USD

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.

Manager – Provider Credentialing

GeneDx

Compensation Overview

Simplify's Take

What believers are saying

What critics are saying

What makes GeneDx unique

Benefits

Company News