Is the Payment Integrity Specialist position at GeneDx fully remote?

Yes, this Payment Integrity Specialist position at GeneDx is fully remote and you can work from anywhere in the world.

Is this a full-time or part-time Payment Integrity Specialist role?

This is a full-time Payment Integrity Specialist position at GeneDx.

What is the salary range for the Payment Integrity Specialist position?

The salary range for this Payment Integrity Specialist role is $70k - $86k.

How do I apply for the Payment Integrity Specialist position at GeneDx?

You can apply for this Payment Integrity Specialist position by clicking the "Apply Now" button on this page, which will take you to GeneDx's application portal.

Payment Integrity Specialist at GeneDx

Worldwide

$70k - $86k

Summary    The Payment Integrity Specialist plays a critical role in ensuring accurate reimbursement and regulatory compliance across payer relationships. This position is responsible for monitoring audits and refund requests, auditing payments against payer contracts, and ensuring adherence to Most Favored Nation (MFN) laws. The specialist will collaborate cross-functionally with billing, appeals, finance, and compliance teams to identify discrepancies, mitigate risks, and optimize revenue integrity.    Job Responsibilities  Audit Oversight  <ul> <li data-leveltext="" data-font="Symbol" data-listid="13" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">Monitor internal and external audits related to claims, payments, and refunds. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="13" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="2" data-aria-level="1">Conduct periodic audits of payer contracts and payment activity to ensure compliance with MFN laws and contractual terms. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="13" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="3" data-aria-level="1">Identify and escalate discrepancies in payment rates, coding, and authorization processes. </li> </ul> Refund and Payment Reconciliation  <ul> <li data-leveltext="" data-font="Symbol" data-listid="14" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">Review and process refund requests from payers and patients. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="14" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="2" data-aria-level="1">Ensure timely and accurate posting of payments and resolution of denials. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="14" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="3" data-aria-level="1">Maintain detailed records of transactions and audit findings. </li> </ul> Contract Compliance  <ul> <li data-leveltext="" data-font="Symbol" data-listid="16" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">Validate that payments align with negotiated payer contracts and MFN provisions. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="16" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="2" data-aria-level="1">Collaborate with legal and contracting teams to interpret and apply MFN rules. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="16" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="3" data-aria-level="1">Support payer configuration reviews and contract audits. </li> </ul> Regulatory Adherence  <ul> <li data-leveltext="" data-font="Symbol" data-listid="18" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">Stay current on federal and state regulations impacting payment integrity, including MFN laws. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="18" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="2" data-aria-level="1">Ensure audit processes and documentation meet compliance standards. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="18" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="3" data-aria-level="1">Assist in preparing responses to regulatory inquiries and payer audits. </li> </ul> Cross-Functional Collaboration  <ul> <li data-leveltext="" data-font="Symbol" data-listid="20" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">Partner with appeals, credentialing, and market access teams to resolve payment issues. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="20" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="2" data-aria-level="1">Provide feedback and process improvement recommendations to operational teams.  </li> <li data-leveltext="" data-font="Symbol" data-listid="20" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="3" data-aria-level="1">Participate in payer meetings and internal workgroups to enhance audit and payment workflows. </li> </ul>   Education, Experience, and Skills  <ul> <li data-leveltext="" data-font="Symbol" data-listid="24" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">Bachelor’s degree in healthcare administration, finance, or related field (or equivalent experience). </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="24" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="2" data-aria-level="1">3–5 years of experience in medical billing, payment integrity, or payer contract auditing. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="24" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="3" data-aria-level="1">Strong understanding of MFN laws, payer policies, and healthcare reimbursement models. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="24" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="4" data-aria-level="1">Proficiency in claims management systems and data analytics tools. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="24" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="5" data-aria-level="1">Exceptional attention to detail, analytical thinking, and problem-solving skills. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="24" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="6" data-aria-level="1">Excellent communication and documentation abilities. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="24" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="7" data-aria-level="1">CPCS or similar certification preferred.  </li> </ul> #LI-REMOTE<div class="content-pay-transparency"><div class="pay-input"><div class="title">Pay Transparency, Budgeted Range</div><div class="pay-range">$70,000—$86,000 USD</div></div></div><div class="content-conclusion"><div class="column _8-col center-element _12-col-tab"> <div class="margin-bottom margin-24"> <h3 class="heading-l">A culture that plays to win, because patients are counting on us</h3> </div> </div> <div class="column _8-col _12-col-tab"> 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 – and shapes our culture where high standards, strong teamwork, and meaningful ownership are the norm. We act with intention, support one another, and deliver work we're proud to put our names on. Here’s what you can expect day to day: 1. Play like a champion (step up, redefine what’s possible, own it) We bring energy, focus, and a bias for action. We step up, take initiative, and deliver on our commitments – with quality, speed, and care. <div class="card-number">2. Think bigger (stretch beyond, courage not consensus)</div> We push past the obvious. We challenge assumptions, raise the bar, and make thoughtful, decisive calls — choosing progress over perfection. <div class="card-number">3. Grow fast (be curious, speak up, be agile)</div> We stay curious, ask questions, and share direct feedback with respect. We adapt quickly and keep learning through collaboration and continuous improvement. If you’re motivated by meaningful work, a fast-moving environment, and teammates who care deeply about outcomes, you’ll thrive at GeneDx. </div> <div>At GeneDx, we believe in taking care of our people. We provide competitive compensation and benefits that reflect local market practices and legal requirements in each country where we operate, helping employees thrive both professionally and personally.</div> We welcome everyone regardless of their background. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, gender, gender identity, sexual orientation, protected veteran status, disability, age, and other characteristics protected by law. GeneDx is a place where people from all backgrounds can make an impact. All privacy policy information can be found <a href="https://www.genedx.com/privacy" target="_blank">here</a>.</div>

Apply Now

Remote Opportunity

Payment Integrity Specialist

Join GeneDx as a mid professional working remotely from Worldwide. Explore the role, benefits, and apply in one place.

Payment Integrity Specialist

GeneDx

Full Time

$70k - $86k

2 months ago

Summary The Payment Integrity Specialist plays a critical role in ensuring accurate reimbursement and regulatory compliance across payer relationships.

Worldwide

Engineering

Mid

Payment Integrity

Payer Contract Auditing

Medical billing

+5 more

Job Description

Summary

The Payment Integrity Specialist plays a critical role in ensuring accurate reimbursement and regulatory compliance across payer relationships. This position is responsible for monitoring audits and refund requests, auditing payments against payer contracts, and ensuring adherence to Most Favored Nation (MFN) laws. The specialist will collaborate cross-functionally with billing, appeals, finance, and compliance teams to identify discrepancies, mitigate risks, and optimize revenue integrity.

Job Responsibilities

Audit Oversight

Monitor internal and external audits related to claims, payments, and refunds.

Conduct periodic audits of payer contracts and payment activity to ensure compliance with MFN laws and contractual terms.

Identify and escalate discrepancies in payment rates, coding, and authorization processes.

Refund and Payment Reconciliation

Review and process refund requests from payers and patients.

Ensure timely and accurate posting of payments and resolution of denials.

Maintain detailed records of transactions and audit findings.

Contract Compliance

Validate that payments align with negotiated payer contracts and MFN provisions.

Collaborate with legal and contracting teams to interpret and apply MFN rules.

Support payer configuration reviews and contract audits.

Regulatory Adherence

Stay current on federal and state regulations impacting payment integrity, including MFN laws.

Ensure audit processes and documentation meet compliance standards.

Assist in preparing responses to regulatory inquiries and payer audits.

Cross-Functional Collaboration

Partner with appeals, credentialing, and market access teams to resolve payment issues.

Provide feedback and process improvement recommendations to operational teams.
Participate in payer meetings and internal workgroups to enhance audit and payment workflows.

Education, Experience, and Skills

Bachelor’s degree in healthcare administration, finance, or related field (or equivalent experience).

3–5 years of experience in medical billing, payment integrity, or payer contract auditing.

Strong understanding of MFN laws, payer policies, and healthcare reimbursement models.

Proficiency in claims management systems and data analytics tools.

Exceptional attention to detail, analytical thinking, and problem-solving skills.

Excellent communication and documentation abilities.

CPCS or similar certification preferred.

#LI-REMOTE

Pay Transparency, Budgeted Range

$70,000—$86,000 USD

A culture that plays to win, because patients are counting on us

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 – and shapes our culture where high standards, strong teamwork, and meaningful ownership are the norm. We act with intention, support one another, and deliver work we're proud to put our names on.

Here’s what you can expect day to day:

1. Play like a champion (step up, redefine what’s possible, own it)

We bring energy, focus, and a bias for action. We step up, take initiative, and deliver on our commitments – with quality, speed, and care.

2. Think bigger (stretch beyond, courage not consensus)

We push past the obvious. We challenge assumptions, raise the bar, and make thoughtful, decisive calls — choosing progress over perfection.

3. Grow fast (be curious, speak up, be agile)

We stay curious, ask questions, and share direct feedback with respect. We adapt quickly and keep learning through collaboration and continuous improvement.

If you’re motivated by meaningful work, a fast-moving environment, and teammates who care deeply about outcomes, you’ll thrive at GeneDx.

At GeneDx, we believe in taking care of our people. We provide competitive compensation and benefits that reflect local market practices and legal requirements in each country where we operate, helping employees thrive both professionally and personally.

We welcome everyone regardless of their background. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, gender, gender identity, sexual orientation, protected veteran status, disability, age, and other characteristics protected by law.

GeneDx is a place where people from all backgrounds can make an impact.

All privacy policy information can be found here.

Skills

Payment Integrity

Payer Contract Auditing

Medical billing

Claims management

Data Analytics

Regulatory Compliance

Revenue Integrity

MFN Laws

Ready to Apply?

Join GeneDx today

Salary Range

$70k - $86k

Posted 2 months ago

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Payment Integrity Specialist

Payment Integrity Specialist

Job Description

A culture that plays to win, because patients are counting on us​

Skills

Ready to Apply?

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