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Claim Dispute & Strategy Analyst

Natera

Natera

IT
Remote
Posted on Wednesday, June 5, 2024

POSITION SUMMARY:

The Claim Dispute & Strategy Analyst is responsible for researching state and payor IDR protocols and analyzing eligible claims that receive under payment or non-payment. This position oversees the billing vendor and process of dispute resolution claim submission and payment requests with payors and third-party dispute resolution entities.

PRIMARY RESPONSIBILITIES:

  • Formulates and develops presentations for project analysis needs from Finance, Billing, Market Access, Product Leads, and other teams as required.
  • Identify functions and barriers that affect ASP and revenue including identifying trends, opportunities, and risks for all payors and products.
  • Research complex benefits and insurance verification using various systems and portals internal and external.
  • Investigate designated payors' literature and agencies, and stay current on new indicators, such as state statutes, laws, and other requirements.
  • Develops strategies to improve reimbursement and reduce denials for assigned payors based on trends and analysis findings.
  • Identifies areas of opportunities for process improvements, automation, and efficiencies.
  • Creates management reports and custom dashboards & visualizations.
  • Initiates and supports projects, initiatives, solutions, and other change management
  • Conducts complex trend review, forecasting, sensitivity analysis, what-if scenarios, and other analyses.
  • Partner with multiple internal cross-functional teams and successfully manage multiple product projects simultaneously.
  • Presents information, analysis, updates, financial risks, and recommendations to a specific audience.
  • Performs analysis of operational, production, financial, and other data.
  • Analyzes payor behaviors, systems, and processes in reimbursement to optimize performance.
  • Ensure data integrity and control over business processes by developing data management best practices.
  • Operationalize business intelligence solutions to highlight strengths and opportunities to meet organizational strategies, objectives, and goals.
  • Analyze large data sets of structured, semi-structured unstructured data to discover data insights and collaborate with business partners to deliver business value.
  • Participates in weekly meetings to review key metrics, workflows, trends, payor performance improvement opportunities, and strategies.
  • This role works with PHI regularly both in paper and electronic form and has access to various technologies to access PHI (paper and electronic) to perform the job.

QUALIFICATIONS:

  • Bachelor's Degree healthcare-related field of study or equivalent experience.
  • Minimum of 5 years of experience in claim analysis, dispute resolution, or appeals and denials experience.
  • Management, Supervisor, or Project management experience preferred.
  • Knowledge of CPT/HCPCS. ICD-10, modifier selection, and UB revenue codes.

KNOWLEDGE, SKILLS, AND ABILITIES:

  • Proficiency with medical or claim billing systems, Microsoft Excel, reporting software, 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 solving, and team player skills.
  • Knowledge of appeal and independent dispute resolution regulations.
  • Ability to navigate across multiple customer demands and balance competing priorities successfully.
  • Ability to analyze, identify, and articulate identified trends and report trends succinctly clearly, and concisely.
  • Ability to independently solve complex problems using critical thinking skills.
  • Maintains confidentiality of sensitive information.
  • Analytical skills required.
  • Ability to think critically and identify the global impact across the revenue cycle with a solution-oriented approach.
  • Ability to develop, implement, and produce complex analysis and reports.

PHYSICAL DEMANDS & WORK ENVIRONMENT:

  • Duties are typically performed in a remote office setting.
  • This position requires the ability to use a computer keyboard, communicate over the telephone and read printed material.
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.
Remote USA
$95,600$119,500 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