operations
Posted YesterdayEDI & Claims Operations Analyst
at Natera
United StatesRemote
Responsibilities
- 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. •
- Identify opportunities to automate manual claim status workflows and improve operational efficiency. •
- 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. •
- Collaborate with internal and external stakeholders to identify systemic issues and implement sustainable corrective actions.
Requirements
- The ideal candidate combines deep healthcare revenue cycle knowledge with strong analytical and problem-solving skills.
- Bachelor's degree or equivalent combination of education and 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. •
- Ability to work independently and drive issues to resolution across multiple teams. •
- Experience working with clearinghouses such as Change Healthcare, Waystar, Experian, Availity, or similar platforms. •
- Understanding of EDI healthcare transactions, including 837 claims, 835 remittances, and claim status transactions. •
- Experience supporting healthcare automation initiatives or workflow optimization projects. •