Associate Director, Billing Strategy - Denials & Appeals

Associate Director, Billing Strategy – Denials & Appeals Position Summary 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.