Coding and Denials Analyst

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 Coding and Denials Analyst plays a critical role in safeguarding revenue integrity and ensuring compliance across the organization. This position is responsible for accurate assignment of ICD-10-CM, CPT, and HCPCS codes, while proactively identifying and addressing claim coding-based denials. Beyond coding accuracy, the analyst collaborates with clinical, billing, and administrative teams to improve documentation quality, reduce revenue leakage, and maintain adherence to payer and regulatory requirements. The role involves addressing coding denial trends, reviewing coding accuracy on claim submissions and coding and pricing custom procedures. 

Job Responsibilities 

• Review clinical documentation and assign accurate ICD-10-CM, CPT, and HCPCS codes in compliance with regulatory and payer requirements. 

• Work daily custom coding, pricing, and patient/client inquiry queues, as applicable, to ensure prior authorization requests and claims are coded accurately, have appropriate pricing and in are compliance with regulatory and payer requirements 

• Investigate and resolve coding-related denials resulting in claim denials and delays in payment.  

• Identify and analyze coding denial patterns from worklists and collaborate cross functionally on strategies to reduce revenue leakage.  

• Collaborate with internal revenue cycle management teams to improve coding compliance. 

• Serve as a medical coding resource and subject matter expert for cross functional teams  

• Participate in external audits to review coding integrity. 

• Monitor coding changes, regulatory updates, and payer policy changes. 

• Review reports on coding denials to support root cause analysis and coding accuracy. 

• Participate in ad hoc medical coding related tasks, projects, and inquiries as directed by leadership 

• Complete other duties as assigned 

• Customer Service Standards 

• Support co-workers and engage in positive interactions.  

• Communicate professionally and timely with internal and external customers. 

• Demonstrate friendliness by smiling and making eye contact when greeting all customers.  

• Provide helpful assistance in anticipating and responding to the needs of our customers.  

• Collaborate with customers in planning and decision making to result in optimal solutions.  

• Ability to stay calm under pressure and deal effectively with difficult people 

People Manager 

• No 

Education, Experience, and Skills 

Education 

Associate’s degree in Business, Paralegal Studies, Coding, Communications, or other related field. Two (2) years of relevant experience in Billing, Compliance, Coding, Health Information Management, or Legal experience may be considered in lieu of an associate’s degree in addition to the experience below. 

Experience 

Minimum 2 years of medical coding experience in inpatient, outpatient, or professional services, with exposure to denial management and revenue cycle analytics. 

Skills 

• Strong knowledge of ICD-10-CM, CPT, HCPCS, medical terminology, payer guidelines, and reimbursement methodologies. 

• Proficiency in EHR systems, coding software, and Microsoft Excel for data analysis and coding audits. 

• Excellent analytical, communication, and problem-solving skills. 

• Knowledge of payer guidelines and reimbursement methodologies. 

• Ability to work independently and meet productivity/accuracy standards. 

• Experience with denial management tools and reporting systems. 

• Ability to interpret payer policies and regulatory requirements. 

• Strong attention to detail and ability to meet productivity and accuracy standards. 

• Experience working with third party payors.  

• Excellent oral and written communication skills. 

• Establish and maintain professional and cooperative relationships.  

• Effective human relations abilities.  

• Strong ability to effectively collaborative alliances and promote teamwork. 

Certificates, Licenses, Registrations 

• Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Coding Specialist (CCS), Certified Coding Specialist Physician-Based (CCS-P) or a Certified Coding Associate (CCA required. 

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. 

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