Appeals Analyst
Posted on 4/2/2024
Natera

1,001-5,000 employees

Global leader in personalized genetic testing
Company Overview
Natera stands as a global leader in cell-free DNA testing, with a dedicated focus on oncology, women’s health, and organ health, aiming to integrate personalized genetic testing into standard healthcare practices. The company's competitive advantage lies in its proprietary cfDNA technology platform, which has been validated by over 100 peer-reviewed publications for its high accuracy, and its diverse team of experts from various fields. Natera's commitment to industry leadership is evident in its ISO 13485-certified and CAP-accredited laboratories, and its proactive stance against cyber crimes, ensuring a secure and innovative work environment.
Biotechnology

Company Stage

N/A

Total Funding

$1.2B

Founded

2004

Headquarters

Austin, Texas

Growth & Insights
Headcount

6 month growth

9%

1 year growth

15%

2 year growth

23%
Locations
Remote in USA
Experience Level
Entry
Junior
Mid
Senior
Expert
Desired Skills
Excel/Numbers/Sheets
CategoriesNew
Operations & Logistics
Quality Control & Compliance
Requirements
  • Bachelors Degree in a healthcare related field of study, or equivalent experience.
  • Minimum of 5 years of experience in medical billing and Insurance collections, dispute resolution.
  • Minimum of 3 years appeals experience preferred.
  • Minimum of 3 years of experience in revenue cycle or claim analysis
  • Project management experience preferred.
  • Knowledge of CPT/HCPCS. ICD-10, modifier selection, and UB revenue codes.
  • 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.
Responsibilities
  • Develop, train, and deploy a process to submit and monitor appeals for assigned product. This includes the required appeal letter and package.
  • Establishes the patient authorized appeal process for medical necessity and experimental denials.
  • Project manages patient authorized appeals to see cases are sent to external review.
  • Expand and exhaust provider level appeals (including but not limited to underpaid, out of network, Prior auth, bundling, coding appeals).
  • Monitors claims, identifies trends, presents opportunity areas, and prioritizes initiatives for performance improvement for assigned product.
  • Conducts monthly audits on third-party vendor to ensure process and workflows are being adhered and payment accuracy against contracted reimbursement rate.
  • Establishes an ongoing working relationship with other departments impacting appeal resolution.
  • Works closely with the vendor operations teams to oversee operations activity that directly impact assigned product appeal process.
  • Tracks appeal outcomes for assigned product to ensure KPIs and goals are met.
  • Participates in weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities.
  • Continually reviews and monitors payor appeal changes to determine process update and actions.
  • Coordinates with Management to ensure thorough understanding of trends/issues affecting assigned appeal performance.
  • Performs other duties as assigned.