EDI & Claims Operations Analyst

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $79.4k - $99.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

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Natera

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2004

🧬 Biotechnology

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Biotechnology • Healthcare Insurance • Pharmaceuticals

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

• Monitor claim status activity across clearinghouses and payer systems to ensure claims are successfully transmitted, received, and processed. • Analyze large claim populations to identify trends, bottlenecks, acceptance issues, and payer-specific workflow challenges. • Investigate rejected, unacknowledged, delayed, or "stuck" claims and determine root causes. • Partner with Billing Operations, Insurance Verification, Denials Management, Coding, Configuration, Engineering, and Automation teams to resolve claim processing issues. • Identify opportunities to automate manual claim status workflows and improve operational efficiency. • Serve as a subject matter expert on clearinghouse operations, payer connectivity, claim submission workflows, EDI transactions, and claim status processes. • Research payer-specific requirements, acceptance rules, rejection patterns, and status behaviors. • Develop recommendations for workflow improvements that increase claim acceptance rates and reduce downstream denials. • Track and trend claim status performance metrics and communicate findings to operational leadership. • Support implementation and optimization of automation solutions related to claim status management and payer communications. • Create process documentation, job aids, and operational guidance to support standardized workflows. • Assist with escalation management and complex claim routing decisions. • Collaborate with internal and external stakeholders to identify systemic issues and implement sustainable corrective actions.

🎯 Requirements

• Bachelor's degree or equivalent combination of education and experience. • 4+ years of healthcare revenue cycle experience. • Experience working with claim submission, claim status, claim acceptance/rejection management, or EDI operations. • Strong understanding of healthcare claims workflows and payer processing. • Experience researching and resolving claim transmission, acceptance, or rejection issues. • Advanced Microsoft Excel or Google Sheets skills, including data analysis and reporting. • Strong analytical, investigative, and problem-solving abilities. • Ability to work independently and drive issues to resolution across multiple teams. • Excellent communication and stakeholder management skills.

🏖️ Benefits

• Competitive Benefits - Employee benefits include comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents. • Free testing for Natera employees and their immediate families. • Fertility care benefits. • Pregnancy and baby bonding leave. • 401k benefits. • Commuter benefits. • Generous employee referral program!