Eligibility And Prior Authorization Specialist

Summary

Join Natera as an Eligibility and Prior Authorization Specialist and build strong relationships with internal and external stakeholders. You will manage revenue cycle projects, improve reimbursement performance, and oversee processes impacting cash collections. This role requires expertise in medical billing, eligibility, and prior authorization. You will analyze data, identify trends, and develop improvement initiatives. The position involves leading meetings, coordinating with management, and acting as an educator on performance improvement. Natera offers competitive benefits, including comprehensive medical, dental, vision, life, and disability plans, as well as free testing for employees and their families.

Requirements

• Proficiency with medical billing systems, Microsoft Excel, medical terminology and basic procedure coding knowledge
• Knowledge of medical terminology and abbreviations, and health care nomenclature and systems
• Strong communication (verbal and written), organizational, problem solving and team player skills
• Ability to navigate across multiple customer demands and balance competing priorities successfully
• Ability to analyze, identify and articulate identified trends and report trends succinctly in a clear and concise manner
• Ability to solve problems using critical thinking skills
• Maintain confidentiality of sensitive information
• Analytical skills required
• Ability to think critically and identify the impact across the revenue cycle with a solution oriented approach
• Ability to develop, implement and produce analysis and reports
• At least 3 years of experience in medical billing and Insurance collections
• At least 3 years of experience with Eligibility and Prior Authorization requirements, payer utilization management policies and Appeals
• Knowledge of CPT/HCPCS. ICD-10, modifier selection and UB revenue codes
• Bachelor's Degree
• Healthcare related field of study or equivalent experience

Responsibilities

• Serve as a source of knowledge for the designated revenue cycle function
• Perform analysis, identify trends, present opportunity areas, and prioritize initiatives for performance improvement for the designated revenue cycle function
• Develop appropriate workflows and tracking for the designated revenue cycle function
• Establish an ongoing working relationship with other departments impacting revenue cycle performance
• Work closely with various vendor operations teams (Prior authorization, Claims and Appeals) to oversee operations activity that directly impacts the revenue cycle to accurately process actions in a timely manner for optimal reimbursement
• Track outcomes of payment resolution, appeals, and negotiated claims to ensure goals are met
• Lead weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities
• By continually reviewing and monitoring eligibility and prior authorization changes, research, evaluate, and interpret guidance from a variety of sources to determine departmental actions
• Coordinate with Management to ensure thorough understanding of trends/issues affecting revenue cycle performance
• Develop goals and metrics to link department and revenue cycle initiatives with the organization's strategy
• Develop, manage and monitor successful completion of implementation and project plans
• Act as an educator on performance improvement requirements in operations and methodologies to related teams and departments
• Continuously seek new and creative technologies that help identify and guide improvement opportunities that align with overall company success

Benefits

• Comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents
• Free testing in addition to fertility care benefits for employees and their immediate families
• Pregnancy and baby bonding leave
• 401k benefits
• Commuter benefits
• Generous employee referral program