[Hiring] Eligibility and Prior Authorization Specialist @Natera

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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.
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