Supervisor, Prior Authorization Strategy & Policy

Summary

Join Natera as a Supervisor, Prior Authorization Strategy and Policy, leading the Prior Authorization Advocacy and Requirements team. You will manage staff, oversee job aid creation, obtain prior authorization requirements, and create resources for navigating payer portals. Collaborate with cross-functional teams to align on prior authorization processes and optimize reimbursement strategies. Analyze data to identify trends and improve revenue cycle management. Conduct data analysis on team production and workflow changes to inform workload volume and headcount planning. Manage all aspects of the prior authorization department, ensuring timely and accurate submissions and collections. This role requires regular work with protected health information (PHI).

Requirements

• Bachelor’s Degree in related field, or equivalent years of professional experience required
• Minimum of 3 years of experience in managing a high volume, fast growing billing team; within the laboratory setting is preferred
• Extensive knowledge of reimbursement, billing, coding, prior authorizations and compliance regulations is required
• Training in fields such as business administration, accountancy, computer sciences or similar vocations
• Normally requires a minimum of two (2) years directly related and progressively responsible experience within Revenue Cycle and Prior Authorizations
• Ability to perform complex analysis and discuss with upper management
• Skilled in Microsoft Office: Word and Excel (advanced)
• Ability to communicate effectively both orally and in writing
• Strong interpersonal skills, organizational skills, including attention to detail
• Extensive knowledge of payer authorization requirements
• Health care research and analysis skills sufficient to support payer research healthcare policy library and state management
• Ability to resolve associate issues effectively and efficiently

Responsibilities

• Develop metrics, KPIs and SLAs for onshore and offshore team, as well as workflows, SOPs and best practices
• Direct self and others in areas of responsibility such as research, prior authorization, order entry and eligibility
• Analyze data from payors to identify trends, assess financial performance, and provide insights to improve revenue cycle management and prior authorization functions
• Serves as the communication hub for the prior authorization team coordinating payor, process, and overall departmental updates
• Utilize technical expertise in the system to investigate and analyze insurance payor requirements for prior authorization, ensuring compliance and streamlined approvals
• Collaborate cross-functionally with Market Access, Sales, and Billing Strategy teams to align on prior authorization processes, optimize reimbursement strategies, and enhance overall patient access
• Conduct data analysis on team production, process improvements and workflow changes, in order to deliver insights on impacts related to workload volume, headcount planning, forecasted revenue, etc
• Assists with feedback for hiring, discipline and performance evaluations
• Provides department orientation and ongoing training for all in/direct reports
• 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
• This role works with PHI on a regular basis both in paper and electronic form and have an access to various technologies to access PHI (paper and electronic) in order to perform the job

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!