Associate Director, Billing Strategy – Denials & Appeals

Role Overview

• 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.
• 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.
• Translate denial and appeals workflows into system logic, partnering with engineering and vendors to support automation buildout.
• Define requirements for rules-based workflows, denial routing, and appeal triggers within billing systems (e.g., AMD).
• Support automation initiatives (e.g., rules engines, RPA, 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, failure points, and gaps in automation logic before and after deployment.
• Analyze datasets using tools such as 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 is strongly preferred.
• 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 tools such as Power BI, Excel, SQL, or Snowflake.
• Experience leading cross-functional initiatives and influencing stakeholders without direct authority.

Tech Stack

• RPA
• SQL

Benefits

• 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.