Revenue Cycle Claims Denials And Appeals Specialist

Summary

Join Natera as a Revenue Cycle Denials and Appeals Specialist and contribute to the company's success in revenue cycle management. You will build strong relationships within the organization, manage projects, drive performance improvements, and provide oversight of processes impacting cash collections. Responsibilities include analyzing data, identifying trends, developing workflows, and collaborating with various departments and vendors. You will lead meetings, research billing and coding changes, and develop goals and metrics aligned with the organization's strategy. This role requires at least 3 years of experience in medical billing and insurance collections, along with knowledge of CPT/HCPCS, ICD-10, and medical terminology. Natera offers competitive benefits, including comprehensive medical, dental, vision, life, and disability plans, as well as free testing for employees and their families.

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
• Ability to navigate across multiple customer demands and balance competing priorities successfully
• Ability to analyze, identify and articulate identified trends and report trends succinctly in a clear and concise manner
• Ability to solve problems using critical thinking skills
• Maintains confidentiality of sensitive information
• Analytical skills required
• Ability to think critically and identify the impact across the revenue cycle with a solution oriented approach
• Ability to develop, implement and produce analysis and reports

Responsibilities

• Serve as a source of knowledge for the designated revenue cycle function, with a focus on Denials and Appeals
• Perform analysis, identify trends, present opportunity areas, and prioritize initiatives for performance improvement for the designated revenue cycle function
• Be responsible for developing appropriate workflows and tracking for the designated revenue cycle function
• Establish an ongoing working relationship with other departments impacting revenue cycle performance
• Work closely with various vendor operations teams (Prior authorization, Coding and Billing) to oversee operations activity that directly impacts the revenue cycle to accurately process actions in a timely manner for optimal reimbursement
• Track outcomes of payment resolution, appeals, and negotiated claims to ensure goals are met
• Lead weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities
• By continually reviewing and monitoring billing and coding changes, research, evaluate, and interpret guidance from a variety of sources to determine departmental actions
• Coordinate with Management to ensure thorough understanding of trends/issues affecting revenue cycle performance
• Develop goals and metrics to link department and revenue cycle initiatives with the organization's strategy
• Develop, manage and monitor successful completion of implementation and project plans
• Act as an educator on performance improvement requirements in operations and methodologies to related teams and departments
• Continuously seek 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 for employees and their immediate families
• Pregnancy and baby bonding leave
• 401k benefits
• Commuter benefits
• Generous employee referral program