Hiring Fast, Associate Director, Billing Strategy – Denials & Appeals, Healthcare work from home jobs

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.

The Associate Director will oversee this function from three angles:

• Operational: Oversight and performance management of outsourced RCM teams handling denials and appeals.
• Analytical: Root cause analysis and data-driven insights to improve denial rates and recovery.
• Technical: Defining and supporting system enhancements and automation strategies tied to denial workflows.

Key Responsibilities
Strategy & Payer Advocacy

• 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.

Operations & Root Cause Analysis

• 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.

Data, Systems & Automation

• 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.

Qualifications
Required

• 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.

Preferred

• 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.

Key Traits for Success

• Investigative: Relentless in understanding why denials occur and how to prevent or overturn them.
• Systems Thinker: Able to connect operational workflows with system logic and automation opportunities.
• Data-Driven: Uses data to inform decisions and influence stakeholders.
• Cross-Functional Operator: Effectively partners with engineering, operations, and leadership teams.
• Builder Mindset: Proactive in identifying opportunities and driving improvements with a high degree of ownership.
• 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.

Remote USA

$132,100-$165,100 USD