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We are a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health.
EDI & Claims Operations Analyst
Location
United States
Posted
11 days ago
Salary
$79.4K - $99.2K / year
Seniority
Senior
Job Description
EDI & Claims Operations Analyst
Natera
• Monitor claim status activity across clearinghouses and payer systems to ensure claims are successfully transmitted, received, and processed. • Analyze large claim populations to identify trends, bottlenecks, acceptance issues, and payer-specific workflow challenges. • Investigate rejected, unacknowledged, delayed, or "stuck" claims and determine root causes. • Partner with Billing Operations, Insurance Verification, Denials Management, Coding, Configuration, Engineering, and Automation teams to resolve claim processing issues. • Identify opportunities to automate manual claim status workflows and improve operational efficiency. • Serve as a subject matter expert on clearinghouse operations, payer connectivity, claim submission workflows, EDI transactions, and claim status processes. • Research payer-specific requirements, acceptance rules, rejection patterns, and status behaviors. • Develop recommendations for workflow improvements that increase claim acceptance rates and reduce downstream denials. • Track and trend claim status performance metrics and communicate findings to operational leadership. • Support implementation and optimization of automation solutions related to claim status management and payer communications. • Create process documentation, job aids, and operational guidance to support standardized workflows. • Assist with escalation management and complex claim routing decisions. • Collaborate with internal and external stakeholders to identify systemic issues and implement sustainable corrective actions.
Job Requirements
- Bachelor's degree or equivalent combination of education and experience.
- 4+ years of healthcare revenue cycle experience.
- Experience working with claim submission, claim status, claim acceptance/rejection management, or EDI operations.
- Strong understanding of healthcare claims workflows and payer processing.
- Experience researching and resolving claim transmission, acceptance, or rejection issues.
- Advanced Microsoft Excel or Google Sheets skills, including data analysis and reporting.
- Strong analytical, investigative, and problem-solving abilities.
- Ability to work independently and drive issues to resolution across multiple teams.
- Excellent communication and stakeholder management skills.
Benefits
- Competitive Benefits - Employee benefits include comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents.
- Free testing for Natera employees and their immediate families.
- Fertility care benefits.
- Pregnancy and baby bonding leave.
- 401k benefits.
- Commuter benefits.
- Generous employee referral program!
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