[Hiring] Eligibility and Prior Authorization Specialist @Natera

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Eligibility and Prior Authorization Specialist plays a critical role in Natera’s Revenue Cycle Management (RCM) operations by ensuring accurate insurance verification and timely prior authorization (PA) processing for all testing services. • Validate patient eligibility and submit authorization requests. • Liaise with payors to secure reimbursement approvals. • Support operational efficiency, regulatory compliance, and optimal cash collections. • Act as a subject-matter expert for eligibility and prior authorization workflows. • Contribute to continuous process improvement initiatives across the billing function. Primary Responsibilities • Eligibility Verification & Prior Authorization Processing: • Verify insurance eligibility and benefits through payer portals and internal systems. • Gather and review clinical documentation needed for test authorization. • Submit prior authorization requests through payer-specific platforms. • Conduct timely follow-ups with payors to track authorization status. • Document all updates within the designated RCM systems. • Workflow Management & Documentation: • Follow established workflows for eligibility and PA case management. • Maintain centralized tracking for all authorization submissions and denials. • Protect confidential information and comply with HIPAA and PHI regulations. • Cross-Functional Collaboration: • Build and maintain effective relationships with internal teams across Billing, Order Entry, Claims, and Appeals. • Partner with vendor operations teams to oversee eligibility and authorization activities. • Coordinate with Quality and Compliance teams to ensure regulatory alignment. • Performance Monitoring & Continuous Improvement: • Track key outcomes related to prior authorization approvals and payment resolutions. • Lead or contribute to weekly team meetings reviewing metrics and workflows. • Research and interpret changes in payer utilization management policies. • Develop and monitor project and implementation plans for new workflows. • Identify automation or technology enhancements for operational efficiency. Qualifications • 3+ years of experience in medical billing, insurance collections, or revenue cycle operations. • 3+ years of direct experience in eligibility verification, prior authorization, and payer policy management. • Bachelor’s degree in a healthcare-related field, or equivalent combination of education and professional experience. • Experience using Glidian, payer portals, or comparable prior authorization submission tools strongly preferred. Requirements • Strong proficiency with medical billing systems, insurance portals, and Microsoft Excel. • Understanding of medical terminology, CPT/HCPCS, ICD-10, modifiers, and UB revenue codes. • Proven ability to analyze data, identify trends, and produce clear, concise reports. • Strong critical-thinking, organization, and problem-solving skills. • Excellent written and verbal communication skills. • Attention to detail and accuracy in documentation. • Demonstrated commitment to maintaining confidentiality of sensitive information. • Knowledge of payer utilization management policies and familiarity with appeals and denials workflows. Benefits • Comprehensive medical, dental, vision, life, and disability plans for eligible employees and their dependents. • Free testing for employees and their immediate families. • Fertility care benefits. • Pregnancy and baby bonding leave. • 401k benefits and commuter benefits. • Generous employee referral program.