Payor Credentialing Specialist I

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 Payor Credentialing Assistant 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.

Job Responsibilities

• 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

People Manager -  No

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 and/or Experience  
• 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  

Certificates, Licenses, Registrations  
• None  

Work Environment  
This is a fully remote position. 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.