Manager, Denials and Appeals

Job Title: Manager, Denials and Appeals

Company Overview:

Natera, Inc. is a global leader in cell-free DNA (cfDNA) testing, specializing in oncology, women's health, and organ health. Founded in 2004 and headquartered in Austin, Texas, Natera is dedicated to making personalized genetic testing and diagnostics a standard of care, enabling earlier and more targeted interventions to improve patient outcomes. With over 250 peer-reviewed publications and more than 10 million tests processed in CAP/CLIA-certified labs, Natera continues to advance molecular diagnostics with scientific rigor and integrity. (natera.com)

Job Summary:

We are seeking an experienced and strategic Manager, Denials and Appeals to oversee the denials management and appeals function within our Insurance Billing department. This role will be responsible for ensuring effective denials resolution, reimbursement optimization, and compliance with payer policies. The ideal candidate will lead a team of specialists, collaborate with cross-functional departments, and drive process improvements to enhance revenue cycle performance.

Key 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 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.

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Skills and Qualifications:

• Bachelor’s degree in a related field or equivalent experience required.
• 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.

If you are a results-driven leader with a passion for revenue cycle optimization and denials management, we encourage you to apply and be part of our dynamic team at Natera!