Associate Director, Denials and Appeals

Summary

Join Natera as the Associate Director of Denials and Appeals, leading the billing, collection, and accounts receivable team. You will manage the denials and appeals staff, overseeing all denial and appeal functions while implementing strategic goals. This role requires directing billing management, establishing financial data, analyzing reimbursements, and maximizing cash collections. You will also maintain billing policies, prepare reports, manage continuous improvements, and collaborate with various functional areas. The position involves leadership responsibilities, including performance reviews, hiring decisions, and staff development. This role works with protected health information (PHI) and requires HIPAA/PHI privacy training.

Requirements

• Bachelor’s Degree in related field or equivalent years of experience
• Extensive knowledge of reimbursement, billing, coding and compliance regulations
• Complete training relating to HIPAA/PHI privacy, General Policies and Procedure Compliance training and security training within the first 30 days of hire
• Maintain a current status on Natera training requirements

Responsibilities

• Direct Billing Management and staff to ensure accurate submission of all claims and timely collections in accordance with all third party contract terms including, Medicare, Medical, managed care, commercial insurance, and direct patient pay
• Establish and maintain all billing and financial data, including medical billing code tables, rate schedules and payer information
• Analyze reimbursement from all sources, including carrier reimbursement exception reporting and follow up pending claims analysis and denials management
• Assure maximization of cash collections through diligent and timely monitoring of all open accounts receivable balances
• Maintain and enhance billing policies and procedures for each function in the revenue cycle process and ensure staff adherence to policies
• Prepare detailed analyses and reports of billing and accounts receivable activity and results, including performance matrixes, bad debt expense and AR days outstanding
• Manage for continuous improvements within the revenue cycle process
• Effectively interact with various functional areas
• Provide mentoring, coaching and performance reviews for direct reports
• Manage all outreach billing operations, including hiring, orientation, training, development, coaching, corrective actions, and ongoing monitoring of all staff work-related activities
• Ensure consistent quality of the billing services by distributing and assigning duties and responsibilities to employees, ensuring skill levels are appropriate to the assigned tasks, and monitoring the department’s productivity
• Lead a high performance team responsible for Data Entry, CPT and ICD-10 Coding, Cash Posting, Denial and Accounts Receivable Management, Refunds Processing, and Call Center Operations. Provide leadership, drive change, and facilitate process improvements
• Actively collaborate with the RCM (Billing) Finance team on analysis of billing activity for monthly financial reporting, the sales and marketing team of new and existing clients, and senior management on performance and new initiatives
• Participate in the Compliance Committee for Coding and Billing related items; establish and enforce departmental and company policies and procedures
• Develop and monitor operating procedures and, where necessary, implement changes in workflow to improve productivity. Draft accurate budgeting and forecasting of headcount and cash receipts
• Create and hold billing leadership accountable for established performance and production standards. Maintain billing related quality patient outcomes
• Conduct annual performance evaluations, make hiring decisions, and develop corrective action plans when necessary
• Interface with third party payers to resolve reimbursement issues and provide guidance to appropriate senior leadership regarding contracting challenges
• Provide direction to and development of associates through daily coaching, the administration of Performance Management, and the creation and implementation of development plans
• Assess performance and provide timely and constructive feedback to staff
• Determine additional training needs
• Prepare annual performance evaluations and recommend merit increase and bonus percentages. Promote organizational efficiency, needed change and continuous quality improvement
• Identify and implement opportunities for automation and improved efficiency
• Assist as needed to perform other related duties and special projects as required

Preferred Qualifications

• Minimum of 8 years of experience in managing a high volume, fast growing billing office within the laboratory setting (staff of 50-100)
• Demonstrated leadership ability in a multi-site environment
• Capacity to actively engage and communicate with a wide variety of employees, senior leaders and external auditors to drive change and problem solve
• Ability to respond to change quickly and generate creative ideas and solutions to emerging business changes
• Active, visible and influential leadership style such as ability to directly engage, arrive at conclusions, drive consensus, and monitor actions in support of quality outcomes
• Skilled in researching, interpreting, and presenting data in a concise manner
• Demonstrates strong ability to effectively plan, organize, and delegate
• Leads by example and demonstrates commitment to continual improvement and a passion for excellence
• Maintains a high standard of discipline, professionalism, and sound decision making for excellence. Ability to motivate a highly successful team to exceed performance goals, drive change, and lead a growing staff
• Personable, persuasive, and comfortable navigating all levels of the workforce
• Communication – Proficient verbal and written communication skills
• Willingness to share and receive information and ideas from all levels of the organization in order to achieve the desired results
• Teamwork – Commitment to the successful achievement of team and organizational goals through a desire to participate with and help other members of the team
• Customer Service Focus – Demonstrate a focus on listening to and understanding client/customer needs and then delighting the client/customer by exceeding service and quality expectations

Benefits

• Comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents
• Free testing for employees and their immediate families
• Fertility care benefits
• Pregnancy and baby bonding leave
• 401k benefits
• Commuter benefits
• Generous employee referral program
• Remote work