Associate Director, Billing Strategy – Denials & Appeals

🔥 14 hours ago

🇺🇸 United States – Remote

💵 $132.1k - $165.1k / year

⏰ Full Time

🟠 Senior

📊 Billing Specialist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Natera

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2004

🏥 Healthcare

🧬 Biotechnology

⚕️ Healthcare Insurance

Healthcare • Biotechnology • Healthcare Insurance

Natera is a global leader in cell-free DNA testing technology, specializing in non-invasive genetic testing and diagnostics. The company's innovative solutions focus on areas such as prenatal screening, cancer detection, and organ transplant monitoring. By using advanced bioinformatics and DNA analysis, Natera provides healthcare professionals and patients with critical information to make more informed medical decisions.

📋 Description

• Lead denial management and appeals strategy across all payer types • Define and track overturn rates, appeal timelines, and recovery performance • Serve as an internal expert on payer policies and medical necessity criteria for laboratory testing • Interpret payer policies and guide teams in defending medical necessity in appeals • Identify payer behavior patterns to inform contracting strategy and escalation pathways • Partner with eligibility, prior authorization, coding, and billing teams to proactively prevent denials • Audit BPO/vendor performance, identify workflow gaps, enforce accountability, and drive improvements • Develop job aids and standardized workflows • Analyze denial trends to distinguish avoidable operational issues from systemic or payer-driven challenges • Translate denial and appeals workflows into system logic with engineering and vendors • Define requirements for rules-based workflows, denial routing, and appeal triggers in billing systems such as AMD • Support rules engines, RPA, and AI-driven workflow automation initiatives • Lead UAT and QA for system changes • Identify opportunities to transition processes toward scalable, low-touch or unattended workflows • Identify automation edge cases, failure points, and logic gaps before and after deployment • Analyze datasets using Power BI, SQL, Excel, or Snowflake to quantify denial drivers and financial impact

🎯 Requirements

• 8–12+ years of experience in healthcare Revenue Cycle Management (RCM), with deep focus on denials and appeals • Expertise in laboratory billing, CPT coding, and reimbursement methodologies • Strong 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 • Strong analytical skills with experience using Power BI, Excel, SQL, or Snowflake • Experience leading cross-functional initiatives and influencing stakeholders without direct authority • Preferred: experience supporting revenue-cycle automation initiatives • Preferred: experience partnering with engineering teams or vendors to implement billing system enhancements • Preferred: familiarity with AI-driven workflow concepts • Preferred: experience with AMD or similar billing platforms • Preferred: experience with Jira or similar workflow tracking systems

🏖️ Benefits

• Comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents • Free testing for employees and their immediate families • Fertility care benefits • Pregnancy and baby bonding leave • 401k benefits • Commuter benefits • Employee referral program • Equal Opportunity Employer and inclusive workplace