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Natera

Eligibility and Prior Authorization Specialist

5 giorni fa

Austin

Job Description Position Summary 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. This position is responsible for validating patient eligibility, submitting and tracking authorization requests, and liaising with payors to secure reimbursement approvals—ultimately supporting operational efficiency, regulatory compliance, and optimal cash collections. This role does not involve direct patient interaction, but instead requires extensive coordination with insurance payors, internal RCM teams, and external vendor operations. The specialist acts as a subject-matter expert for eligibility and prior authorization workflows and contributes 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 to confirm active coverage and PA requirements. * Gather and review clinical documentation needed to establish medical necessity for test authorization. * Submit prior authorization requests through payer-specific platforms such as Glidian, Carelon, or Evicore, ensuring complete and accurate information. * Conduct timely follow-ups with payors to track authorization status, resolve discrepancies, and document all updates within the designated RCM systems. * Workflow Management & Documentation * Follow established workflows for eligibility and PA case management, ensuring adherence to quality and productivity metrics (≥90% accuracy). * Maintain centralized tracking for all authorization submissions and denials; escalate complex cases to Supervisors or Analysts when necessary. * Protect confidential information and comply with all 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 impacting the revenue cycle. * Coordinate with Quality and Compliance teams to ensure processes align with regulatory standards and payer requirements. * Performance Monitoring & Continuous Improvement * Track key outcomes related to prior authorization approvals, payment resolutions, and appeal performance. * Lead or contribute to weekly team meetings reviewing metrics, workflows, trends, and process improvement opportunities. * Research and interpret changes in payer utilization management policies and communicate updates to team members. * Develop and monitor project and implementation plans for new workflows, system enhancements, or payer policy updates. * Identify automation or technology enhancements that improve accuracy, turnaround time, and overall operational efficiency. Required Knowledge, Skills, and Abilities * 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; able to balance multiple priorities in a high-volume environment. * Excellent written and verbal communication skills; capable of conveying complex payer requirements clearly. * Attention to detail and accuracy in documentation, with the ability to work independently. * Demonstrated commitment to maintaining confidentiality of sensitive information. * Knowledge of payer utilization management policies and familiarity with appeals and denials workflows. 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. The pay range is listed and actual compensation packages are based on a wide array of factors unique to each candidate, including but not limited to skill set, years & depth of experience, certifications and specific office location. This may differ in other locations due to cost of labor considerations.Austin, TX$25.15—$31.44 USD 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 . 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: 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

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