Manager, Provider Credentialing

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.

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