Eligibility and Prior Authorization Specialist

POSITION SUMMARY:

Eligibility and Prior Authorization Specialist will be responsible for building and maintaining collaborative and productive relationships with internal and external stakeholders relating to eligibility and prior authorization, managing revenue cycle projects, driving performance in operations related to reimbursement and providing direction and oversight of processes impacting cash collections.

PRIMARY RESPONSIBILITIES:

• Serves as a source of knowledge for the designated revenue cycle function.
• Performs analysis, identifies trends, presents opportunity areas, and prioritizes initiatives for performance improvement for the designated revenue cycle function.
• Responsible for developing appropriate workflows and tracking for the designated revenue cycle function.
• Establishes an ongoing working relationship with other departments impacting revenue cycle performance.
• Works closely with various vendor operations teams (Prior authorization, Claims and Appeals) to oversee operations activity that directly impacts the revenue cycle to accurately process actions in a timely manner for optimal reimbursement.
• Tracks outcomes of payment resolution, appeals, and negotiated claims to ensure goals are met.
• Leads weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities.
• By continually reviewing and monitoring eligibility and prior authorization changes, researches, evaluates, and interprets guidance from a variety of sources to determine departmental actions.
• Coordinates with Management to ensure thorough understanding of trends/issues affecting revenue cycle performance.
• Develops goals and metrics to link department and revenue cycle initiatives with the organization's strategy.
• Develops, manages and monitors successful completion of implementation and project plans.
• Acts as an educator on performance improvement requirements in operations and methodologies to related teams and departments.
• Continuously seeks new and creative technologies that help identify and guide improvement opportunities that align with overall company success.

Required Knowledge, Skills and Abilities:

• 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.
• Maintains 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

Qualifications:

• 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
• Bachelor's Degree
• Healthcare related field of study or equivalent experience.

OUR OPPORTUNITY

Natera™ is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health. Our aim is to make personalized genetic testing and diagnostics part of the standard of care to protect health and enable earlier and more targeted interventions that lead to longer, healthier lives.

The Natera team consists of highly dedicated statisticians, geneticists, doctors, laboratory scientists, business professionals, software engineers and many other professionals from world-class institutions, who care deeply for our work and each other. When you join Natera, you’ll work hard and grow quickly. Working alongside the elite of the industry, you’ll be stretched and challenged, and take pride in being part of a company that is changing the landscape of genetic disease management.

WHAT WE OFFER

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!

For more information, visit www.natera.com.

Natera is proud to be an Equal Opportunity Employer. We are committed to ensuring a diverse and inclusive workplace environment, and welcome people of different backgrounds, experiences, abilities and perspectives. Inclusive collaboration benefits our employees, our community and our patients, and is critical to our mission of changing the management of disease worldwide.

All qualified applicants are encouraged to apply, and will be considered without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, age, veteran status, disability or any other legally protected status. We also consider qualified applicants regardless of criminal histories, consistent with applicable laws.

If you are based in California, we encourage you to read this important information for California residents.

Link: https://www.natera.com/notice-of-data-collection-california-residents/

Please be advised that Natera will reach out to candidates with a @natera.com email domain ONLY. Email communications from all other domain names are not from Natera or its employees and are fraudulent. Natera does not request interviews via text messages and does not ask for personal information until a candidate has engaged with the company and has spoken to a recruiter and the hiring team. Natera takes cyber crimes seriously, and will collaborate with law enforcement authorities to prosecute any related cyber crimes.

For more information:

- BBB announcement on job scams
- FBI Cyber Crime resource page