Associate Director, Denials and Appeals

Associate Director, Denials And Appeals

The Associate Director of Denials and Appeals will effectively lead the billing, collection and accounts receivable team while maintaining a full understanding of Natera's billing information system and all aspects of revenue cycle management. The Associate Director also manages the activities of the Denials and Appeals staff through daily supervision while overseeing all denial and appeal functions. The Associate Director executes and implements strategic goals for through the utilization of their leadership team. The Associate Director leads individuals who direct and plan daily workflow activities for billing staff members. The Associate Director functions as a member of the leadership team in strategic planning and advisory capacities.

Primary Responsibilities :

• Directs Billing Management and staff to ensure that accurate submission of all claims and timely collections occurs in accordance with all third party contract terms including, Medicare, Medical, managed care, commercial insurance, and direct patient pay.
• Establishes and maintains all billing and financial data, including medical billing code tables, rate schedules and payer information.
• Analyzes reimbursement from all sources, including carrier reimbursement exception reporting and follow up pending claims analysis and denials management.
• Assures maximization of cash collections through diligent and timely monitoring of all open accounts receivable balances.
• Maintains and enhance billing policies and procedures for each function in the revenue cycle process and ensure staff adherence to policies.
• Prepares detailed analyses and reports of billing and accounts receivable activity and results, including performance matrixes, bad debt expense and AR days outstanding.
• Manages for continuous improvements within the revenue cycle process.
• Effectively interacts with various functional areas Provides mentoring, coaching and performance reviews for direct reports.
• Manages all outreach billing operations, including hiring, orientation, training, development, coaching, corrective actions, and ongoing monitoring of all staff work-related activities.
• Ensures consistent quality of the billing services by distributing and assigning duties and responsibilities to employees, ensuring skill levels are appropriate to the assigned tasks, and monitoring the department's productivity.
• Leads a high performance team responsible for Data Entry, CPT and ICD-10 Coding, Cash Posting, Denial and Accounts Receivable Management, Refunds Processing, and Call Center Operations. Provides leadership, drives change, and facilitates process improvements.
• Actively collaborates with the RCM (Billing) Finance team on analysis of billing activity for monthly financial reporting, the sales and marketing team of new and existing clients, and senior management on performance and new initiatives.
• Participates in the Compliance Committee for Coding and Billing related items; establishes and enforces departmental and company policies and procedures.
• Develops and monitors operating procedures and, where necessary, implements changes in workflow to improve productivity. Drafts accurate budgeting and forecasting of headcount and cash receipts.
• Creates and holds billing leadership accountable for established performance and production standards. Maintains billing related quality patient outcomes
• Conducts annual performance evaluations, makes hiring decisions, and develops corrective action plans when necessary.
• Interfaces with third party payers to resolve reimbursement issues and provides guidance to appropriate senior leadership regarding contracting challenges.
• Provides direction to and development of associates through daily coaching, the administration of Performance Management, and the creation and implementation of development plans.
• Assesses performance and provides timely and constructive feedback to staff.
• Determines additional training needs.
• Prepares annual performance evaluations and recommends merit increase and bonus percentages. Promotes organizational efficiency, needed change and continuous quality improvement.
• Identifies and implements opportunities for automation and improved efficiency.
• Assists as needed to perform other related duties and special projects as required.
• This role works with PHI on a regular basis both in paper and electronic form and has access to various technologies to access PHI (paper and electronic) in order to perform the job
• Employee must complete training relating to HIPAA / PHI privacy, General Policies and Procedure Compliance training and security training as soon as possible but not later than the first 30 days of hire.
• Must maintain a current status on Natera training requirements.

Qualifications :

Knowledge, Skills, And Abilities :

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.

Austin, TX

$133,900 - $175,000 USD