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SalaryPOSITION SUMMARY:
The Appeal Analyst is responsible for researching claims that are eligible for an appeal for their assigned
product. This position develops the appeal letter, package, and process for the billing vendor to execute
while overseeing the appeal process and submission.
PRIMARY RESPONSBILITIES:
- Develop, train, and deploy a process to submit and monitor appeals for assigned product. This
- 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,
- Monitors claims, identifies trends, presents opportunity areas, and prioritizes initiatives for
- Conducts monthly audits on third-party vendor to ensure process and workflows are being
- 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
- 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
- Continually reviews and monitors payor appeal changes to determine process update and
- Coordinates with Management to ensure thorough understanding of trends/issues affecting
- Performs other duties as assigned
QUALIFICATIONS:
- 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.
REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:
- Proficiency with medical or claim billing systems, Microsoft Excel, reporting software and basic
- Knowledge of medical terminology and abbreviations, and health care nomenclature and systems.
- Strong communication (verbal and written), organizational, problem solving and team player skills.
- Knowledge of appeal process and procedures.
- Ability to navigate across multiple customer demands and balance competing priorities
- Ability to analyze, identify and articulate identified trends and report trends succinctly in a clear
- Ability to independently solve complex problems using critical thinking skills.
- Maintains confidentiality of sensitive information.
- Analytical skills required.
- Ability to develop, implement and produce complex analysis and reports.
OUR OPPORTUNITY
Natera™ is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women's health, and organ health. Our aim is to make personalized genetic testing and diagnostics part of the standard of care to protect health and enable earlier and more targeted interventions that lead to longer, healthier lives.
The Natera team consists of highly dedicated statisticians, geneticists, doctors, laboratory scientists, business professionals, software engineers and many other professionals from world-class institutions, who care deeply for our work and each other. When you join Natera, you'll work hard and grow quickly. Working alongside the elite of the industry, you'll be stretched and challenged, and take pride in being part of a company that is changing the landscape of genetic disease management.
WHAT WE OFFER
Competitive Benefits - Employee benefits include comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents. Additionally, Natera employees and their immediate families receive free testing in addition to fertility care benefits. Other benefits include pregnancy and baby bonding leave, 401k benefits, commuter benefits and much more. We also offer a generous employee referral program!
For more information, visit www.natera.com.
Natera is proud to be an Equal Opportunity Employer. We are committed to ensuring a diverse and inclusive workplace environment, and welcome people of different backgrounds, experiences, abilities and perspectives. Inclusive collaboration benefits our employees, our community and our patients, and is critical to our mission of changing the management of disease worldwide.
All qualified applicants are encouraged to apply, and will be considered without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, age, veteran status, disability or any other legally protected status. We also consider qualified applicants regardless of criminal histories, consistent with applicable laws.
If you are based in California, we encourage you to read this important information for California residents.
Link: https://www.natera.com/notice-of-data-collection-california-residents/
Please be advised that Natera will reach out to candidates with a @natera.com email domain ONLY. Email communications from all other domain names are not from Natera or its employees and are fraudulent. Natera does not request interviews via text messages and does not ask for personal information until a candidate has engaged with the company and has spoken to a recruiter and the hiring team. Natera takes cyber crimes seriously, and will collaborate with law enforcement authorities to prosecute any related cyber crimes.
- BBB announcement on job scams
- FBI Cyber Crime resource page
