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Director, Denials and Appeals Program

Natera

Natera

Remote
Posted on Wednesday, May 17, 2023



POSITION SUMMARY:

In this role, the successful candidate will be responsible for the development, direction, and management of the Natera Denials & Appeals Program in support of all business units and products to design and implement solutions to reduce denial root causes, increase appeals success, and improve product revenues and ASPs. This includes the development and oversight of systems that scale to support all business units within Natera (Oncology, Women’s Health, Organ Health) and each of the corresponding products for those BUs. This individual will oversee the development and execution of SOPs for internal teams and external 3rd party vendors to exhaust all available appeals to include both provider and patient authorized avenues in conjunction with support of other internal stakeholders (Billing, Market Access, product marketing, Compliance, etc). This individual will provide oversight and auditing of all functions across all products and regularly communicate strategy, tactics, and performance to senior leadership.

  • Serves as a subject matter expert while staying up to date on oncology regulations affecting Denial Prevention and Management practice.
  • Provides leadership, training, and direction to internal denial type leads and product focused appeals analysts to reduce administrative denial types through improved operational efficiencies and implements standardized and scalable processes to increase appeal success rate among mature and developing product offerings.


PRIMARY RESPONSIBILITIES:


Develops and implements Standards of Practice for the entire organization supporting all business units and products. Oversees external vendor execution and supports the internal Appeals Specialists teams’ efforts as it relates to formulating and submitting responses to payer denials.

  • Manages and prioritizes timely review, investigation and response to payer denials and the required actions for appeals within contractual timeframes.
  • Conducts ongoing oversight of the Denials and Appeals Team to analyze adverse determinations, timely review and response to payor denials, and maintenance of department metrics.
  • Coordinates and collaborates with Content Experts across the enterprise (Physicians, Physician Advisors, Clinical Service Lines, Case Management, Health Information Management, Clinical Documentation Improvement, Inpatient and Outpatient Revenue Services, etc) as needed to obtain necessary documentation to support oncology and genetic appeals and implement prevention.
  • Assists with the development, maintenance, and management of cases utilizing an internal tracking tool for the distribution of reports as requested by Leadership.
  • Identifies, monitors and presents monthly denial performance trends utilizing case studies with recommendations for Process Improvements to the Revenue Cycle Management Team.
  • Identifies potential risk for lost reimbursement related to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care, and revenue cycle leadership, as appropriate.
  • Participates in company-wide strategic meetings as needed.

QUALIFICATIONS

Bachelor’s degree required.

Master’s in Business Administration or other health related field preferred.

5-7 years of Director Level laboratory focused revenue cycle management experience including 5 years in Claims Denial Management, Appeals Management, or related experience and 3 years of current experience with reimbursement methodologies.

KNOWLEDGE, SKILLS, AND ABILITIES

Strong communication (verbal and written) and interpersonal skills
Ability to communicate with multiple levels of the organization: Senior Leadership, Physicians, Directors, Clinical and Support Staff
Demonstrates strong critical thinking and analytical skills
Ability to work collaboratively in a team environment
Demonstrates the ability to handle multiple assignments and carry out work independently with minimal supervision
Demonstrates responsibility for professional development
Ability to work a flexible schedule to ensure compliance with deadlines
Experience preparing appeals for proprietary CDLTs
Certification in Clinical Documentation Improvement
Qualified candidates must be able to effectively communicate with all levels of the organization.

#LI-TR1

The pay range is listed and actual compensation packages are based on a wide array of factors unique to each candidate, including but not limited to skill set, years & depth of experience, certifications and specific office location. This may differ in other locations due to cost of labor considerations.
New York
$137,000$206,900 USD

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