Natera
healthcare
AssociateDirector,BillingStrategy-Denials&Appeals
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“Associate Director, Billing Strategy - Denials & Appeals at Natera. Skills: denial management strategy, payer advocacy, reimbursement outcomes, automation strategies, root cause analysis, data analysis. lead the strategy, performance, and optimization of denied claims and appeals. shaping denial management strategy”
What You'll Achieve.
improve reimbursement outcomes; improve denial rates and recovery; track overturn rates, appeal timelines, and recovery performance; reduce manual work by transitioning denial and appeal processes toward scalable, low-touch or unattended workflows; quantify denial drivers and financial impact
Industry & Context.
Root cause analysis; data-driven insights; analytical skills; Investigative
What They're Looking For.
Must Have
8–12+ years of experience in healthcare Revenue Cycle Management (RCM), with deep focus on denials and appeals, knowledge of commercial, Medicare, Medicaid, and managed care payer policies, Demonstrated success improving appeal overturn rates and resolving medical necessity denials, Experience working with BPO or offshore RCM vendors, analytical skills with experience using tools such as Power BI, Excel, SQL, or Snowflake, Experience leading cross-functional initiatives and influencing stakeholders without direct authority
Nice to Have
Expertise in laboratory billing, CPT coding, and reimbursement methodologies is strongly preferred, Experience supporting automation initiatives in revenue cycle (e.g., rules engines, RPA, or workflow automation tools), Experience partnering with engineering teams or vendors to implement billing system enhancements, Familiarity with AI-driven workflow concepts (e.g., intelligent routing, decisioning) in an operational setting, Experience with AMD or similar billing platforms, Experience with tools such as Jira or similar workflow tracking systems
What You'll Do.
and optimization of denied claims and appeals
shaping denial management strategy
driving payer advocacy
partnering cross-functionally to improve reimbursement outcomes
supporting automation initiatives across denial and appeals workflows
translating operational expertise into system logic
partnering with engineering and vendors to scale processes through technology
oversight and performance management of outsourced RCM teams handling denials and appeals
root cause analysis and data-driven insights to improve denial rates and recovery
defining and supporting system enhancements and automation strategies tied to denial workflows
Lead denial management and appeals strategy across all payer types
Define and track overturn rates
and recovery performance
Act as an internal expert on payer policies and medical necessity criteria for laboratory testing
Interpret payer policies and guide teams on defending medical necessity in appeals
Identify payer behavior patterns to inform contracting strategy and escalation pathways
Partner with eligibility
and billing teams to proactively prevent denials
Audit BPO/vendor performance using data to identify workflow gaps
enforce accountability
and drive improvements
Develop job aids and standardized workflows to improve consistency and quality
Analyze denial trends to distinguish between avoidable operational issues and systemic or payer-driven challenges
Translate denial and appeals workflows into system logic
partnering with engineering and vendors to support automation buildout
Define requirements for rules-based workflows
and appeal triggers within billing systems
Support automation initiatives (e.g.
AI-driven workflows) by providing domain expertise and guiding design decisions
Lead UAT and QA for system changes
ensuring outputs align with payer policy and real-world denial scenarios
Identify opportunities to reduce manual work by transitioning denial and appeal processes toward scalable
low-touch or unattended workflows
Proactively identify edge cases
and gaps in automation logic before and after deployment
Analyze datasets using tools such as Power BI
or Snowflake to quantify denial drivers and financial impact
How You'll Work.
Team & Collaboration
partnering cross-functionally to improve reimbursement outcomes; partnering with engineering and vendors to scale processes through technology; Partner with eligibility, prior authorization, coding, and billing teams to proactively prevent denials; partnering with engineering and vendors to support automation buildout; providing domain expertise and guiding design decisions; Experience leading cross-functional initiatives and influencing stakeholders without direct authority; Experience partnering with engineering teams or vendors to implement billing system enhancements
Communication Scope
influencing stakeholders without direct authority
Process & Methodology
Experience leading cross-functional initiatives
Full Job Description
Associate Director, Billing Strategy – Denials & Appeals Position Summary Natera is seeking an Associate Director, Billing Strategy – Denials & Appeals to lead the strategy, performance, and optimization of denied claims and appeals. This is a senior individual contributor role responsible for shaping denial management strategy, driving payer advocacy, and partnering cross-functionally to improve reimbursement outcomes. This role will also play a key part in supporting automation initiatives across denial and appeals workflows. This will involve translating operational expertise into system logic and partnering with engineering and vendors to scale processes through technology. The Associate Director will oversee this function from three angles: Operational: Oversight and performance management of outsourced RCM teams handling denials and appeals. Analytical: Root cause analysis and data-driven insights to improve denial rates and recovery. Technical: Defining and supporting system enhancements and automation strategies tied to denial workflows. Key Responsibilities Strategy & Payer Advocacy Lead denial management and appeals strategy across all payer types. Define and track overturn rates, appeal timelines, and recovery performance. Act as an internal expert on payer policies and medical necessity criteria for laboratory testing. Interpret payer policies and guide teams on defending medical necessity in appeals. Identify payer behavior patterns to inform contracting strategy and escalation pathways. Operations & Root Cause Analysis Partner with eligibility, prior authorization, coding, and billing teams to proactively prevent denials. Audit BPO/vendor performance using data to identify workflow gaps, enforce accountability, and drive improvements. Develop job aids and standardized workflows to improve consistency and quality. Analyze denial trends to distinguish between avoidable operational issues and systemic or payer-driven challenges. Data, Systems & Automation
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