Claim Dispute & Strategy Analyst

The Claim Dispute & Strategy Analyst is responsible for researching state and payor protocols and analyzing eligible claims that receive under payment or non-payment. This position oversees the billing vendor and process of dispute resolution, claim submission and payment requests with payors and third-party dispute resolution entities. Translate data into meaningful information and knowledge that supports decision-making or determining action that drives performance improvement and quality. Influence designated payor policy changes to impact product coverage.

PRIMARY RESPONSIBILITIES:

•    Serves as a source of knowledge for the designated payor operations and performance.
•    Complete position responsibilities within the appropriate time frame while adhering to quality standards.
•    Translate data into meaningful information and knowledge that supports decision-making or determining action that drives performance improvement        and quality.
•    Influence contract negotiations with designated out-of-network payors.
•    Track outcomes of payment resolutions, appeals, and negotiated claims to ensure goals are met.
•    Performs analysis, identifies trends, and presents opportunities for designated payors to increase ASP and revenue.
•    Participates in weekly meetings to review key metrics, workflows, trends, payor performance improvement opportunities, and strategies.
•    Continuously seeks new and creative technologies that help identify and guide improvement opportunities that align with overall company success.
•    Provides recommendations by performing analysis of operational, production, and other data of designated payor.
•    Analyzes payor behaviors, systems, and processes to determine pathways available for advanced filings.
•    Analyzes reimbursement from all sources, including carrier reimbursement and follow-up on pending claims and denial management.
•    Researches complex benefits and insurance verification using various systems and portals internal and external.
•    Investigate designated payors' literature and agencies, and stay current on new indicators, such as state statutes and laws, and other requirements.
•    Identify and escalate missing information across departments to manage the accuracy of patient records.
•    Responsible for verifying patient insurance coverage, to ensure necessary procedures are covered by an individual’s provider.
•    Auditing data for accuracy of patient benefit information in multiple systems and verifying existing information.

•    Coordinates with Management to ensure a thorough understanding of trends/issues affecting payor trends.
•    Develops, manages, and monitors successful completion of implementation of projects with vendors.
•    Manages all aspects of the denial management for designated payors including timely and accurate advanced filing submissions and outreach for all        patient authorizations, as assigned.
•    Handles escalations requiring specialized and advanced reviews including state and federal arbitration entities, CMS, and the Department of                    Insurance.
•    Partner with multiple internal cross-functional teams and successfully manage multiple product projects simultaneously.
•    Establishes an ongoing working relationship with other departments impacting designated payors' performance.
•    Works closely with vendor operations to oversee activity that directly impacts designated payors to accurately process actions on time.
•    Communicates designated payor performance in operations and methodologies to related teams and departments.
•    Presents information, analysis, and updates to various levels and types of audiences.
•    Communicates and cooperates with state and federal agencies to enforce statutes and laws.
•    This role works with PHI on a regular basis both in paper and electronic form and utilizes various technologies to access PHI (paper and electronic) in order to perform the job.

QUALIFICATIONS:

•    Bachelor's Degree healthcare-related field of study or equivalent experience.
•    Minimum of 5 years of experience in claim analysis, dispute resolution, or appeals and denials experience.
•    Management, Supervisor, or Project management experience preferred.
•    Knowledge of CPT/HCPCS. ICD-10, modifier selection, and UB revenue codes

KNOWLEDGE, SKILLS, AND ABILITIES:

•    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.
•    Strong communication (verbal and written), organizational, problem-solving solving, and team player skills.
•    Knowledge of appeal and independent dispute resolution regulations.
•    Ability to navigate across multiple customer demands and balance competing priorities successfully.

•    Ability to analyze, identify, and articulate identified trends and report trends succinctly clearly, and concisely.
•    Ability to independently solve complex problems using critical thinking skills.
•    Maintains confidentiality of sensitive information.
•    Analytical skills required.
•    Ability to think critically and identify the global impact across the revenue cycle with a solution- oriented approach.
•    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.

For more information:
- BBB announcement on job scams 
- FBI Cyber Crime resource page