Denials and Appeals Manager

Summary

Join Natera, a global leader in cell-free DNA testing, as a Manager, Denials and Appeals. You will lead a team, overseeing denials management and appeals to optimize reimbursement and ensure compliance. Responsibilities include supervising staff, developing strategic initiatives, analyzing payer patterns, and collaborating with cross-functional departments. The ideal candidate possesses strong leadership, analytical, and communication skills, along with extensive experience in medical billing and denials management within a healthcare setting. Natera offers competitive benefits, including comprehensive medical, dental, vision, life, and disability plans, as well as free testing for employees and their families. This role is based in San Carlos, CA, with a salary range of $95,000-$120,000 USD.

Requirements

• Bachelor’s degree in a related field or equivalent experience
• 5+ years of experience managing a high-volume, fast-paced billing office, preferably within a laboratory or healthcare setting
• Strong knowledge of medical billing, denials management, appeals processes, reimbursement methodologies, and payer compliance regulations
• Experience leading large teams, with a focus on coaching, training, and performance management
• Proficiency in billing systems, revenue cycle management tools, and data analysis platforms
• Strong problem-solving, analytical, and organizational skills with the ability to manage multiple projects simultaneously
• Excellent communication and leadership skills, with the ability to collaborate effectively across departments
• Knowledge of insurance verification, coding regulations, and payer contract analysis
• Ability to adapt to a fast-growing environment and drive continuous improvement initiatives

Responsibilities

• Lead and manage the denials and appeals team, ensuring efficiency, accuracy, and compliance in all aspects of the revenue cycle
• Oversee daily operations of denials management, including billing, eligibility verification, collections, and appeals processes
• Supervise and provide ongoing training for staff, ensuring they stay updated on payer policies, reimbursement trends, and best practices
• Develop and implement strategic initiatives to reduce denials, improve collections, and optimize reimbursement processes
• Analyze payer reimbursement patterns, identifying trends, risks, and opportunities for improvement
• Serve as a liaison between internal departments, ensuring clear communication and collaboration on revenue cycle projects
• Ensure timely, accurate submission and collection of all claims, proactively identifying and resolving issues that impact reimbursement
• Collaborate with insurance verification, billing, and collections teams to streamline workflows and enhance operational efficiency
• Monitor and validate adherence to company policies, compliance regulations, and payer guidelines, conducting audits as necessary
• Track KPIs and performance metrics, providing insights and recommendations to senior leadership to improve revenue cycle outcomes
• Build and maintain a positive team culture, fostering engagement, motivation, and professional growth
• Maintain strict confidentiality and compliance with Protected Health Information (PHI) regulations, ensuring secure handling of sensitive data

Benefits

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