Revenue Cycle Claims Denial and Appeals Specialist

Summary

Join our team as a Revenue Cycle Claims Specialist and contribute to the success of Natera, a global leader in cell-free DNA testing. As a key member of our revenue cycle function, you will be responsible for building relationships, managing projects, and driving performance improvement.

Requirements

• At least 3 years of experience in medical billing and Insurance collections
• At least 3 years of experience with Prior Authorization requirements, payer utilization management policies and Appeals
• Knowledge of CPT/HCPCS. ICD-10, modifier selection and UB revenue codes
• Healthcare related field of study or equivalent experience
• Proficiency with medical billing systems, Microsoft Excel, medical terminology and basic procedure coding knowledge
• Knowledge of medical terminology and abbreviations, and health care nomenclature and systems
• Strong communication (verbal and written), organizational, problem solving and team player skills

Responsibilities

• Serves as a source of knowledge for the designated revenue cycle function
• Performs analysis, identifies trends, presents opportunity areas, and prioritizes initiatives for performance improvement for the designated revenue cycle function
• Responsible for developing appropriate workflows and tracking for the designated revenue cycle function
• Establishes an ongoing working relationship with other departments impacting revenue cycle performance
• Works closely with various vendor operations teams (Prior authorization, Claims and Appeals) to oversee operations activity that directly impacts the revenue cycle to accurately process actions in a timely manner for optimal reimbursement
• Tracks outcomes of payment resolution, appeals, and negotiated claims to ensure goals are met
• Leads weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities
• By continually reviewing and monitoring billing and coding changes, researches, evaluates, and interprets guidance from a variety of sources to determine departmental actions
• Coordinates with Management to ensure thorough understanding of trends/issues affecting revenue cycle performance
• Develops goals and metrics to link department and revenue cycle initiatives with the organization's strategy
• Develops, manages and monitors successful completion of implementation and project plans
• Acts as an educator on performance improvement requirements in operations and methodologies to related teams and departments
• Continuously seeks new and creative technologies that help identify and guide improvement opportunities that align with overall company success

Benefits

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