Eligibility And Prior Authorization Specialist

Summary

Join Natera, a global leader in cell-free DNA testing, as an Eligibility and Prior Authorization Specialist. You will be responsible for building strong relationships with stakeholders, managing revenue cycle projects, driving performance improvements, and overseeing processes impacting cash collections. This role requires expertise in medical billing, eligibility, and prior authorization. You will analyze trends, identify opportunities, and develop strategies to optimize reimbursement. Natera offers competitive benefits, including comprehensive medical, dental, vision, life, and disability plans, as well as free testing for employees and their families. The ideal candidate will possess strong analytical, communication, and problem-solving skills, along with relevant experience in medical billing and insurance collections.

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

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
• Establish an ongoing working relationship with other departments impacting revenue cycle performance
• Work closely with various vendor operations teams (Billing, 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
• 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

Preferred Qualifications

• Bachelor's Degree preferred
• Healthcare related field of study or equivalent years of professional work experience

Benefits

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