Payor Credentialing Specialist I
Offer summary
Qualifications:
High School Diploma or GED required; bachelor's degree preferred., 1-2 years of experience in a healthcare administrative role, preferably in credentialing., Familiarity with Medicare, Medicaid, and commercial health plans is essential., Strong organizational, communication, and attention to detail skills are necessary..Key responsabilities:
- Assist in the preparation and submission of credentialing applications for payors.
- Maintain and update credentialing databases and files, ensuring accuracy.
- Support EDI/EFT/ERA enrollment efforts with payors and communicate with internal departments.
- Stay informed about changes in payor requirements and assist in resolving credentialing issues.
Job description
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.
JOB SUMMARY
The Payor Credentialing Specialist I supports the credentialing team by assisting with provider portal access for approved GeneDx and third-party users, EDI/EFT/ERA enrollments direct to payors or via Xifin, and by providing accurate credentialing data for our commercial and government payors. This role ensures that all necessary documentation is accurately prepared and submitted in a timely manner, helping to maintain compliance with payor regulations.
MAJOR DUTIES AND RESPONSIBILITIES: include the following. Other duties may be assigned.
- Assist in the preparation and submission of credentialing applications for payors
- Maintain and update credentialing databases and files, ensuring all documentation is complete and accurate
- Assist with payor portal updates, providing access for both internal and external users, as needed
- Support EDI/EFT/ERA enrollment efforts with payors
- Communicate with internal departments to gather necessary information requested by our payors
- Assist in resolving any issues or discrepancies related to credentialing
- Stay informed about changes in payor requirements and regulations
- Support the credentialing team with administrative tasks as needed
SUPERVISORY RESPONSIBILITIES
This job has no supervisory responsibilities.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
COMPETENCIES
Mathematical, computer, reasoning, and language skills at the professional level.
EDUCATION/TECHNICAL REQUIREMENTS
- High School Diploma or GED required; bachelor’s degree preferred
- Minimum of 1-2 years of experience in a healthcare administrative role, preferably in credentialing
- Familiar with Medicare, Medicaid, Managed Medicaid Care Organizations, and commercial/private health plans
- Ability to identify and cultivate relationships with key points of contact to drive business objectives
- Strong organizational ability, proficient communication skills, and excellent attention to detail
- Ability to manage multiple tasks simultaneously in a fast-pace, deadline driven environment
- Proficiency in Microsoft Office Suite, Monday.com, and Salesforce, preferred
~
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.
Required profile
Experience
Other Skills
- Microsoft Office
- Organizational Skills
- Time Management
- Detail Oriented
- Communication
- Problem Solving
Related jobs
BruntWork
- Remote: Philippines
- Freelance
Nachhilfeunterricht
- Remote: Germany
- Freelance
- 28 - 67K
PlaceMe Recruitment
- Remote: Ireland, California (USA), Georgia (USA)
- Full time
Perceptual Consultores Ltda.
- Remote: Chile
- Full time
Coinbase
- Remote: United States
- Full time