Associate Director, Billing reputed company - Denials & Appeals

Associate Director, Billing reputed company – Denials & Appeals Position reputed company reputed company is seeking an Associate Director, Billing reputed company – Denials & Appeals to reputed company the reputed company, performance, and optimization of denied claims and appeals. This is a senior individual contributor role responsible for shaping denial management reputed company, driving payer advocacy, and partnering cross-functionally to improve reimbursement reputed company. This role will also play a key part in supporting automation initiatives across denial and appeals workflows. This will involve translating operational expertise into system logic and partnering with engineering and vendors to reputed company processes through technology. The Associate Director will reputed company this function from three angles: Operational: reputed company and performance management of outsourced RCM teams handling denials and appeals. Analytical: reputed company 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 reputed company & Payer Advocacy reputed company denial management and appeals reputed company across reputed company payer types. Define and reputed company overturn rates, appeal timelines, and recovery performance. reputed company as an internal expert on payer policies and medical necessity reputed company for laboratory testing. Interpret payer policies and guide teams on defending medical necessity in appeals. Identify payer behavior patterns to inform contracting reputed company and escalation reputed company. Operations & reputed company 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. reputed company job aids and standardized workflows to improve consistency and reputed company. 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 reputed company. Define requirements for rules-based workflows, denial routing, and appeal triggers reputed company billing systems (e.g., AMD). Support automation initiatives (e.g., rules engines, RPA, AI-driven workflows) by providing domain expertise and guiding design reputed company. reputed company UAT and QA for system changes, ensuring outputs reputed company with payer policy and reputed company-world denial scenarios. Identify opportunities to reduce reputed company work by transitioning denial and appeal processes toward reputed company, 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, reputed company, or reputed company to quantify denial drivers and financial reputed company.

Qualifications

Required 8–12+ years of experience in reputed company reputed company Cycle Management (RCM), with deep reputed company on denials and appeals. Expertise in laboratory billing, CPT coding, and reimbursement methodologies is strongly preferred. Strong knowledge of reputed company, Medicare, reputed company, and managed care payer policies. Demonstrated reputed company 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, reputed company, SQL, or reputed company. Experience leading cross-functional initiatives and influencing stakeholders without reputed company authority. Preferred Experience supporting automation initiatives in reputed company 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 reputed company Investigative: reputed company in understanding why denials occur and how to prevent or overturn them. Systems Thinker: reputed company to connect operational workflows with system logic and automation opportunities. Data-Driven: Uses data to inform reputed company and influence stakeholders. Cross-Functional Operator: Effectively partners with engineering, operations, and leadership teams. Builder reputed company: Proactive in identifying opportunities and driving improvements with a high degree of ownership. Low Ego, High Accountability: reputed company on reputed company and team reputed company over individual recognition. OUR OPPORTUNITY reputed company™ is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health. Our aim is to reputed company personalized genetic testing and diagnostics part of reputed company of care to protect health and reputed company earlier and more targeted interventions that reputed company to longer, healthier lives. The reputed company 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 reputed company other. reputed company you join reputed company, you’ll work hard and grow quickly. Working alongside the reputed company 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. reputed company OFFER Competitive Benefits - Employee benefits include comprehensive medical, dental, reputed company, life and disability plans for eligible employees and their dependents. Additionally, reputed company employees and their immediate families receive free testing in reputed company 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.reputed company.com. reputed company 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. reputed company reputed company applicants are encouraged to apply, and will be considered without reputed company to race, reputed company, religion, gender, gender identity or reputed company, sexual orientation, national reputed company, genetics, age, veteran status, disability or any other legally protected status. We also consider reputed company 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. reputed company: https://www.reputed company.com/notice-of-data-collection-california-residents/ Please be advised that reputed company will reputed company out to candidates with a @reputed company.com email domain ONLY. Email communications from reputed company other domain names are not from reputed company or its employees and are fraudulent. reputed company does not request interviews reputed company text messages and does not ask for personal information until a candidate has reputed company with reputed company and has spoken to a recruiter and the hiring team. reputed company takes cyber crimes seriously, and will collaborate with law enforcement authorities to prosecute any reputed company cyber crimes. For more information: - BBB announcement on job scams - FBI Cyber Crime resource page Apply To This Job