Eligibility and Prior Authorization Specialist

Summary

Join Natera as an Eligibility and Prior Authorization Specialist and contribute to the efficient functioning of the revenue cycle. You will conduct thorough prior authorization reviews, accurately document activities, address denied authorizations, and serve as a knowledge resource. Responsibilities include performing analysis, identifying trends, and improving processes. You will collaborate with internal and external stakeholders to ensure timely and accurate processing for optimal reimbursement. This role requires strong communication, analytical, and problem-solving skills, along with experience in medical billing and insurance collections.

Requirements

• Proficiency in medical billing systems, payer portals, and Microsoft Excel
• Strong knowledge of medical terminology, abbreviations, and coding standards (CPT/HCPCS, ICD-10, modifiers, UB revenue codes)
• Ability to work independently and collaboratively to manage multiple tasks in a fast-paced environment
• Critical thinking skills to identify trends, articulate findings, and implement solutions that impact the revenue cycle
• Strong communication (verbal and written), organizational, and problem-solving skills
• Analytical skills to assess data and navigate competing priorities effectively
• Maintain confidentiality of sensitive information
• 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

Responsibilities

• Conduct thorough prior authorization case reviews and follow-ups, ensuring all attempts are exhausted before escalating to vendors and/or internal teams
• Accurately document all authorization activities, follow-ups, and outcomes in the designated systems and trackers
• Address denied or delayed authorizations by investigating issues, providing necessary documentation, and submitting appeals as required
• Exercise critical thinking to evaluate case statuses, identify escalation triggers, and route unresolved issues to appropriate teams or vendors
• Serve as a source of knowledge for the designated revenue cycle function
• Perform analysis, identify trends, and prioritize initiatives for performance improvement in the designated revenue cycle area
• Establish ongoing working relationships with other departments that impact revenue cycle performance
• Work closely with various vendor operations teams (Prior Authorization, Claims, and Appeals) to oversee operations activity and ensure timely and accurate processing for optimal reimbursement
• Track outcomes of payment resolutions, appeals, and negotiated claims to ensure goals are met
• Monitor eligibility and prior authorization changes, research, evaluate, and interpret guidance from various sources to determine departmental actions
• Coordinate with management to address trends and issues affecting revenue cycle performance

Preferred Qualifications

At least an Associate’s Degree preferred; Bachelor’s Degree in a healthcare-related field or equivalent experience is highly desirable

Benefits

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