Clinical Data Reviewer

POSITION SUMMARY:

The Clinical Data Reviewer Is responsible for the accurate and timely work to effect filing of Insurance claims both pre and post claim submission.  This person will identify invalid clinical values to help drive clean claims and revenue pull through on all products and services. 

 This position will support the Clinical Data Specialist team and report to the Clinical Data Specialist Supervisor

Essential Duties and Responsibilities:

- Identify order and reimbursement deficiencies - both clinical and code related 

- Investigate and correct, where appropriate, deficient clinical claim information 

- Identify and escalate missing, and sometimes invalid, clinical order data for timely contact   resolution with supporting cross functional teams

- Partner with multiple internal cross-functional teams and successfully manage multiple product projects simultaneously. 

- Research claim and account information using various systems and portals internal and external

- Stay current with relevant medical billing regulations, rules and guidelines

- Complete position responsibilities within the appropriate time frame while adhering to quality standards

- Translate data into meaningful information and knowledge that supports decision making or determining action that drives performance improvement and quality

- Identifies and uses internal and external sources of information for benchmarking and comparative performance, which includes networking with clinical communities, researching literature and agencies, and staying current on new indicators and other requirements

- Support and comply with the company’s policies and procedures. 

- Maintains strictest confidentiality, and adheres to all HIPAA guidelines/regulations

- Regular and reliable attendance.

- Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90% of a typical working day.

- Ability to meet productivity and quality standards set by Clinical Data Specialists.

Qualifications:

Minimum Qualifications:

- 1+ years professional coding experience and understanding of International Classification of Diseases (ICD-10) and Coding Procedure Terminology (CPT) and HCPCS coding.

- Authorization to work in the United States without sponsorship. 

- Superior organization skills, detail oriented, and ability to be persistent and follow through

- Problem-solving, ability to adapt, flexibility in approaches to accomplishing tasks, and ability to independently arrive at creative solutions to problems

- Excellent communication skills, both verbal and written, particularly the ability to convey technical information in an accessible and understandable manner

- Ability to work both independently and in collaboration with individuals from various disciplines

 

Preferred Qualifications:

- 2+ years of experience coding in the medical/healthcare billing area- Lab a plus

- Any years of experience in the revenue cycle function to include third party payer experience.

- Understanding of professional coding, documentation, medical billing processes.

- Knowledge and familiarization with Medicare billing regulations and reimbursement methodologies for Laboratory

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.New York$17—$21 USD

OUR OPPORTUNITY

Natera™ is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health. Our aim is to make personalized genetic testing and diagnostics part of the standard of care to protect health and enable earlier and more targeted interventions that lead to longer, healthier lives.

The Natera 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 each other. When you join Natera, you’ll work hard and grow quickly. Working alongside the elite 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.

WHAT WE OFFER

Competitive Benefits - Employee benefits include comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents. Additionally, Natera employees and their immediate families receive free testing in additio