Associate Director, Billing Strategy - Denials & Appeals

3 hours, 24 minutes ago
Full-time
Lead
Data Science and Analytics
Natera

Natera

Natera specializes in cell-free DNA testing, providing advanced genetic testing services for oncology, women's health, and organ health to help families diagnose and manage genetic diseases.

Pharmaceuticals
1K-5K
Founded 2004

Description

  • Lead denial management and appeals strategy across all payer types.
  • Define, track, and improve overturn rates, appeal timelines, and recovery performance.
  • Serve as an internal expert on payer policies and medical necessity criteria for laboratory testing.
  • Interpret payer policies and guide appeal strategy for medical necessity denials.
  • Identify payer behavior patterns to inform contracting strategy and escalation pathways.
  • Partner with eligibility, prior authorization, coding, and billing teams to proactively prevent denials.
  • Audit outsourced RCM/BPO vendor performance to identify workflow gaps and drive accountability.
  • Develop job aids and standardized workflows to improve consistency and quality.
  • Analyze denial trends to separate operational issues from systemic or payer-driven challenges.
  • Translate denial and appeal workflows into system logic and support automation with engineering and vendors.
  • Define requirements for rules-based workflows, denial routing, and appeal triggers in billing systems.
  • Lead UAT and QA for system changes and validate outputs against payer policy and real-world scenarios.
  • Use data analysis to quantify denial drivers and financial impact.

Requirements

  • 8–12+ years of experience in healthcare Revenue Cycle Management (RCM) with deep focus on denials and appeals.
  • Expertise in laboratory billing, CPT coding, and reimbursement methodologies is strongly preferred.
  • Strong knowledge of commercial, Medicare, Medicaid, and managed care payer policies.
  • Demonstrated success improving appeal overturn rates and resolving medical necessity denials.
  • Experience working with BPO or offshore RCM vendors.
  • Strong analytical skills with experience using Power BI, Excel, SQL, or Snowflake.
  • Experience leading cross-functional initiatives and influencing stakeholders without direct authority.
  • Experience supporting automation initiatives in revenue cycle, such as rules engines, RPA, or workflow automation tools (preferred).
  • Experience partnering with engineering teams or vendors to implement billing system enhancements (preferred).
  • Familiarity with AI-driven workflow concepts such as intelligent routing and decisioning in an operational setting (preferred).
  • Experience with AMD or similar billing platforms (preferred).
  • Experience with Jira or similar workflow tracking systems (preferred).

Benefits

  • Competitive medical, dental, vision, life, and disability benefits for eligible employees and dependents.
  • Free testing for employees and their immediate families.
  • Fertility care benefits.
  • Pregnancy and baby bonding leave.
  • 401(k) benefits.
  • Commuter benefits.
  • Generous employee referral program.

Interested in this position?

Apply directly on the company website

Apply Now

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