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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