Manager, Prior Authorizations

Summary

Join Natera as a Prior Authorization Manager and lead the Prior Authorization functional area within billing, collection, or accounts receivable management. Manage a large remote team of Prior Authorization Specialists, ensuring they meet production metrics and KPIs. Provide department orientation and ongoing training, act as a liaison with internal departments, and analyze prior authorization outcomes. Manage all aspects of the prior authorization department, ensuring timely and accurate submissions and collections. Work across departments to manage the entire process from insurance verification to final collection and build employee morale and loyalty. This role involves regular work with PHI (Protected Health Information) in both paper and electronic forms.

Requirements

• Bachelor’s Degree in related field or equivalent years of relevant experience required
• Minimum of 5 years of experience in managing a high volume, fast growing billing team; within the laboratory setting is preferred
• Extensive knowledge of reimbursement, billing, coding and compliance regulations is required
• Proficiency in utilizing Microsoft Excel and reporting functions (Pivot tables, VLOOKUPS, etc.)
• Experience in training in fields such as business administration, accountancy, sales, marketing, computer sciences or similar vocations
• Experienced in the supervision of staff of a pre-certification department
• Experience with directing self and others in areas of responsibility such as research, appeals, order entry, pre-certification and eligibility
• Two (2) years of experience in prior authorization and insurance billing
• Ability to perform complex analysis and discuss with upper management
• Ability to communicate effectively both orally and in writing
• Strong interpersonal skills and organizational skills, including attention to detail
• Knowledge of payer eligibility and benefits
• Experience in healthcare research and analysis skills sufficient to support payer research healthcare policy library and state management
• Ability to resolve associate issues effectively and efficiently

Responsibilities

• Responsible for managing a large remote team of Prior Authorization Specialists and ensuring they meet production metrics and KPIs
• Assists with feedback for hiring, discipline and performance evaluations
• Provides department orientation and ongoing training for all in/direct reports
• Acts as a liaison with internal departments to promote ongoing communication, and collaboration on cross functional projects related to prior authorization
• Analyzes prior authorization outcomes from all sources, including carrier reimbursement exception reporting and follow up pending prior authorization analysis and denials management
• Represent organizational projects and assist management with follow-through and implementation of initiatives
• Manage all aspects of the prior authorization department including the timely, accurate submission and collection of all patient and customer accounts
• Works with across departments to manage the entire process from insurance verification to final collection
• Responsible for the timely accurate submission of all prior authorizations for service to the responsible payer
• Ensure that all payers needing prior authorization are set up correctly within the software system
• Monitors and validates adherence to Policies and Procedures, auditing as necessary. Monitors and evaluates employee productivity and performance to goal
• Builds employee morale, motivation and loyalty by fostering positive working relationships

Benefits

• Competitive Benefits - Employee benefits include comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents
• Additionally, Natera employees and their immediate families receive free testing in addition to fertility care benefits
• Other benefits include pregnancy and baby bonding leave, 401k benefits, commuter benefits and much more
• We also offer a generous employee referral program!