RCM Claim Status Manager

Position Summary

The RCM Claim Status Manager is a fully remote leadership role within Natera’s Billing Operations / Revenue Cycle Management organization. This individual will oversee a team responsible for the accurate and timely retrieval, review, and documentation of claim status information across a broad range of third-party payers, including Medicare, Medicaid, managed care organizations, and commercial insurance carriers.

This role is highly operational and execution focused. The ideal candidate brings deep knowledge of revenue cycle workflows, EDI claim status transactions (particularly 276/277), payer portal navigation, and claim follow-up operations. They must be able to lead distributed teams, drive productivity and quality standards, identify workflow inefficiencies, and partner cross-functionally to resolve claim processing issues impacting reimbursement.

The successful candidate is organized, detail-oriented, metrics-driven, and comfortable operating in a high-volume environment where accountability, responsiveness, and process consistency are critical.

Key Responsibilities

• Lead, coach, and develop a remote team of RCM claim specialists responsible for claim status follow-up and resolution activities
• Oversee daily operations related to electronic claim status inquiries and payer communications across Medicare, Medicaid, and commercial insurance carriers
• Ensure timely and accurate documentation of payer responses, claim statuses, denials, and follow-up actions within internal systems
• Monitor productivity, quality, and turnaround time metrics to ensure departmental SLAs and performance expectations are consistently achieved
• Identify claim processing trends, workflow bottlenecks, and payer-related issues impacting reimbursement or operational efficiency
• Escalate and resolve complex claim discrepancies, EDI transaction issues, and payer response inconsistencies
• Serve as a subject matter expert for 276/277 claim status transactions and related EDI workflows
• Partner with Billing Operations, Denials, Payment Posting, Cash Applications, and other RCM teams to improve claim lifecycle management
• Analyze reporting and operational data to identify opportunities for process improvement and automation
• Support onboarding, training, and ongoing performance management of team members
• Maintain compliance with company policies, payer requirements, HIPAA regulations, and internal quality standards
• Assist leadership with operational reporting, staffing assessments, and workflow optimization initiatives

Qualifications

Required Qualifications

• Bachelor’s degree or equivalent combination of education and relevant RCM experience
• 5+ years of progressive Revenue Cycle Management experience within healthcare billing operations
• 2+ years of leadership or people management experience within an RCM, claims, or billing operations environment
• Strong understanding of healthcare claims workflows and payer follow-up processes
• Hands-on experience with EDI transactions, specifically 276/277 claim status transactions
• Experience working with Medicare, Medicaid, managed care, and commercial payer portals
• Proven ability to manage remote teams and drive accountability in a high-volume production environment
• Strong analytical, organizational, and problem-solving skills
• Experience utilizing billing systems, clearinghouses, and payer systems to research and resolve claim issues
• Advanced communication skills with the ability to collaborate cross-functionally and manage escalations effectively
• Proficiency in Microsoft Excel and reporting tools used within RCM operations

Preferred Qualifications

• Experience within molecular diagnostics, laboratory billing, or high-complexity healthcare reimbursement environments
• Familiarity with clearinghouse platforms and claim status automation tools
• Experience leading operational improvement or workflow optimization initiatives
• Knowledge of denials management, payment posting, or cash application workflows
• Lean, Six Sigma, or process improvement experience is a plus