Mgr, Revenue Cycle-Denials & Appeals

Job Summary:

Effectively leads the Denials & Appeals functional area within billing, collection or accounts receivable management, maintaining a full understanding of the billing information system. Manages the activities of staff through daily supervision while overseeing designated functional area across revenue cycle including but not limited to billing and pre-certification. Assists with implementing strategic goals by deploying internal and external staff.

Job Responsibilities:

• Experience with Managing large teams, including supervision of staff of a pre-certification department.

• Experience with directing self and others in areas of responsibility such as research, appeals, order entry, pre-certification and eligibility.

• Assists with feedback for hiring, discipline and performance evaluations.

• Provides department orientation and ongoing training for all in/direct reports.

• Liaison with internal departments to promote ongoing communication, and collaboration on cross functional projects related to prior authorization.

• Analyzes prior authorization outcomes from all sources, including carrier reimbursement exception reporting and follow up pending prior authorization analysis and denials management.

• Represent organizational projects and assist management with follow-through and implementation of initiatives.

• Manage all aspects of the prior authorization department including the timely, accurate submission and collection of all patient and customer accounts.

• Works with across departments to manage the entire process from insurance verification to final collection.

• Responsible for the timely accurate submission of all prior authorizations for service to the responsible payer.

• Ensure that all payers needing prior authorization are set up correctly within the software system.

• Monitors and validates adherence to Policies and Procedures, auditing as necessary. Monitors and evaluates employee productivity and performance to goal.

• Builds employee morale, motivation and loyalty by fostering positive working relationships.

• This role works with PHI on a regular basis both in paper and electronic form and have an access to various technologies to access PHI (paper and electronic) in order to perform the job.

QUALIFICATIONS:

• Bachelor’s Degree in related field or equivalent required

• Minimum of 5 years of experience in managing a high volume, fast growing billing office within the laboratory setting is preferred.

• Extensive knowledge of reimbursement, billing, coding and compliance regulations is required.

KNOWLEDGE, SKILLS, AND ABILITIES:

Training in fields such as business administration, accountancy, sales, marketing, computer sciences or similar vocations. Normally requires a minimum of two (2) years directly related and progressively responsible experience. Ability to perform complex analysis and discuss with upper management. Skilled in Microsoft Office: Word and Excel. Ability to communicate effectively both orally and in writing. Strong interpersonal skills. Strong organizational skills, including attention to detail. Knowledge of payer eligibility and benefits. Health care research and analysis skills sufficient to support payer research healthcare policy library and state management. Ability to resolve associate issues effectively and efficiently.

PHYSICAL DEMANDS & WORK ENVIRONMENT:

Duties are typically performed in an office setting. This position requires the ability to use a computer keyboard, communicate over the telephone and read printed material. Duties may require working outside normal working hours (evenings and weekends) at times.

OUR OPPORTUNITY

Natera™ is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health. Our aim is to make personalized genetic testing and diagnostics part of the standard of care to protect health and enable earlier and more targeted interventions that lead to longer, healthier lives.

The Natera team consists of highly dedicated statisticians, geneticists, doctors, laboratory scientists, business professionals, software engineers and many other professionals from world-class institutions, who care deeply for our work and each other. When you join Natera, you’ll work hard and grow quickly. Working alongside the elite of the industry, you’ll be stretched and challenged, and take pride in being part of a company that is changing the landscape of genetic disease management.

WHAT WE OFFER

Competitive Benefits - Employee benefits include comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents. Additionally, Natera employees and their immediate families receive free testing in addition to fertility care benefits. Other benefits include pregnancy and baby bonding leave, 401k benefits, commuter benefits and much more. We also offer a generous employee referral program!

For more information, visit www.natera.com.

Natera is proud to be an Equal Opportunity Employer. We are committed to ensuring a diverse and inclusive workplace environment, and welcome people of different backgrounds, experiences, abilities and perspectives. Inclusive collaboration benefits our employees, our community and our patients, and is critical to our mission of changing the management of disease worldwide.

All qualified applicants are encouraged to apply, and will be considered without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, age, veteran status, disability or any other legally protected status. We also consider qualified applicants regardless of criminal histories, consistent with applicable laws.

If you are based in California, we encourage you to read this important information for California residents.

Link: https://www.natera.com/notice-of-data-collection-california-residents/

Please be advised that Natera will reach out to candidates with a @natera.com email domain ONLY. Email communications from all other domain names are not from Natera or its employees and are fraudulent. Natera does not request interviews via text messages and does not ask for personal information until a candidate has engaged with the company and has spoken to a recruiter and the hiring team. Natera takes cyber crimes seriously, and will collaborate with law enforcement authorities to prosecute any related cyber crimes.

For more information:

- BBB announcement on job scams
- FBI Cyber Crime resource page