VP, Billing & Reimbursement

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 Vice President of Billing and Reimbursement is responsible for leading GeneDx strategies for billing operations and reimbursement optimization. This role requires deep expertise in the complexities of genetic testing reimbursement, including payer policies, prior authorization, coding, and appeals. The VP will drive strategic initiatives to improve revenue cycle performance, ensure regulatory compliance, and support sustainable growth in a rapidly evolving genomic testing landscape.

 Job Responsibilities

Strategic Leadership:

• Develop and implement a comprehensive billing and reimbursement strategy
• Monitor payer claim reimbursement trends, policy changes, and regulatory developments affecting reimbursement.
• Collaborate with clinical leadership and key stakeholders to promote importance of accurate documentation in patient care, financial performance and quality reporting.
• Partner with executive leadership to align billing operations with business goals and market expansion.

Revenue Cycle Oversight:

• Lead all aspects of the revenue cycle, charge capture, coding (CPT, PLA, Tier 1/2), claims submission, payment posting, and denial management.
• Partner with Market Access on payer contract negotiations and reimbursement modeling for new and existing tests.
• Ensure accurate and timely billing to commercial insurers, Medicare, Medicaid, and third-party administrators.

Compliance and Risk Management:

• Ensure compliance with CMS, HIPAA, OIG, and payer-specific billing requirements
• Lead internal audits and implement corrective actions to mitigate risk and ensure audit readiness.

Team Leadership:

• Build, lead, and mentor a high-performing billing and reimbursement team with specialized knowledge in genetic testing.
• Establish and regularly report KPIs and performance metrics to drive accountability and continuous improvement.

Technology and Process Optimization:

• Collaborate with Lab Operations, Finance, and Product and Technology to optimize billing systems, automation tools, and data analytics platforms.
• Identify and implement process improvements to reduce denials, improve cash flow, and enhance the patient billing experience.

Stakeholder Engagement:

• Serve as the primary liaison with billing vendors, legal counsel, and regulatory bodies.
• Collaborate with clinical, compliance, and commercial teams to support test launch readiness and payer education.

 Education, Experience, and Skills

• Bachelor’s degree in Healthcare Administration, Finance, Business, or related field (Master’s preferred).
• Minimum 10 years of experience in medical billing and reimbursement, with at least 5 years in a leadership role within a genetic or molecular diagnostics lab.
• In-depth knowledge of genetic test coding (CPT, PLA, Z-codes), payer coverage policies, and reimbursement methodologies.
• Proven success in navigating complex payer landscapes and improving revenue cycle performance.
• Strong leadership, analytical, and communication skills.
• Experience with billing platforms such as Xifin or similar systems.

Preferred Certifications:

• Certified Professional Coder (CPC)
• Certified Revenue Cycle Executive (CRCE)
• Certified Healthcare Financial Professional (CHFP)

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