副总监，计费策略 - 拒绝与申诉

Natera is seeking an Associate Director, Billing Strategy – Denials & Appeals to lead the strategy, performance, and optimization of denied claims and appeals. This is a senior individual contributor role responsible for shaping denial management strategy, driving payer advocacy, and partnering cross-functionally to improve reimbursement outcomes.

This role will also play a key part in supporting automation initiatives across denial and appeals workflows—translating operational expertise into system logic and partnering with engineering and vendors to scale processes through technology.

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.

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.

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.

Experience supporting automation initiatives in revenue cycle (e.g., rules engines, RPA, or workflow automation tools).

Experience partnering with engineering teams or vendors to implement billing system enhancements.

Familiarity with AI-driven workflow concepts (e.g., intelligent routing, decisioning) in an operational setting.

Experience with AMD or similar billing platforms.

Experience with tools such as Jira or similar workflow tracking systems.

Low Ego, High Accountability: Focused on outcomes and team success over individual recognition.

The pay range is listed and actual compensation packages are based on a wide array of factors unique to each candidate, including but not limited to skill set, years & depth of experience, certifications and specific office location. This may differ in other locations due to cost of labor considerations.

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.

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.

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.

- 10+ years of experience in revenue cycle management, billing, denials, or appeals, with a focus on strategy and performance optimization

- Deep expertise in payer policies, medical necessity criteria, and appeals processes, particularly for laboratory testing

- Experience defining and tracking metrics such as overturn rates, appeal timelines, and recovery performance

- Strong analytical skills for root cause analysis and data-driven insights to improve denial rates and recovery

- Ability to develop job aids and standardized workflows to improve consistency and quality

- Cross-functional collaboration skills, particularly with eligibility, prior authorization, coding, and billing teams

- Experience translating operational expertise into system logic and supporting automation initiatives

- Strong understanding of payer behavior patterns and their implications for contracting strategy and escalation pathways

- Senior individual contributor experience, with the ability to influence without direct authority