The Eligibility and Prior Authorization Specialist is responsible for building and maintaining collaborative relationships with internal and external stakeholders to support eligibility verification and prior authorization processes. This role involves managing revenue cycle projects, driving operational performance related to reimbursement, and overseeing processes impacting cash collections.
Primary Responsibilities:
Conduct thorough prior authorization case reviews and follow-ups, ensuring all attempts are exhausted before escalating to vendors and/or internal teams. Accurately document all authorization activities, follow-ups, and outcomes in the designated systems and trackers. Address denied or delayed authorizations by investigating issues, providing necessary documentation, and submitting appeals as required. Exercise critical thinking to evaluate case statuses, identify escalation triggers, and route unresolved issues to appropriate teams or vendors. Serve as a source of knowledge for the designated revenue cycle function. Perform analysis, identify trends, and prioritize initiatives for performance improvement in the designated revenue cycle area. Establish ongoing working relationships with other departments that impact revenue cycle performance. Work closely with various vendor operations teams (Prior Authorization, Claims, and Appeals) to oversee operations activity and ensure timely and accurate processing for optimal reimbursement. Track outcomes of payment resolutions, appeals, and negotiated claims to ensure goals are met. Monitor eligibility and prior authorization changes, research, evaluate, and interpret guidance from various sources to determine departmental actions. Coordinate with management to address trends and issues affecting revenue cycle performance. Required Knowledge, Skills, and Abilities:
Proficiency in medical billing systems, payer portals, and Microsoft Excel. Strong knowledge of medical terminology, abbreviations, and coding standards (CPT/HCPCS, ICD-10, modifiers, UB revenue codes). Ability to work independently and collaboratively to manage multiple tasks in a fast-paced environment. Critical thinking skills to identify trends, articulate findings, and implement solutions that impact the revenue cycle. Strong communication (verbal and written), organizational, and problem-solving skills. Analytical skills to assess data and navigate competing priorities effectively. Maintain confidentiality of sensitive information. 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. At least an Associate’s Degree preferred; Bachelor’s Degree in a healthcare-related field or equivalent experience is highly desirable. Pay Range:
The pay range for this role is $23–$28/hr. Actual compensation packages are based on a variety of factors, including skills, experience, certifications, and specific office location.
#LI-REMOTE
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.Remote USA$23—$28 USDOUR 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