Supervisor, Prior Authorization Strategy & Policy

Natera • Remote • 2d ago

About Natera

Natera is a global leader in cell-free DNA (cfDNA) testing, dedicated to helping families and healthcare providers make more informed decisions. Through cutting-edge technology and a commitment to innovation, Natera offers genetic testing solutions that span reproductive health, oncology, and organ health. We are passionate about delivering accurate, actionable insights that improve patient outcomes and transform the way diseases are detected and managed.

POSITION SUMMARY:

The Supervisor, Prior Authorization Strategy and Policy will effectively lead the Prior Authorization Advocacy and Requirements team, while maintaining a full understanding of the billing information system as well as cross-functional teams within the Insurance Billing department. The Supervisor will manage the activities of staff through daily supervision while overseeing job aid creation, obtaining Prior Authorization requirements, and creating resources for navigating payer portals and submission/obtainment processes for Prior Authorizations. They will work closely with the manager to own various projects, and assists with implementing strategic goals for internal and external staff.

PRIMARY RESPONSIBILITIES:

Develop metrics, KPIs and SLAs for onshore and offshore team, as well as workflows, SOPs and best practices.
Direct self and others in areas of responsibility such as research, prior authorization, order entry and eligibility.
Analyze data from payors to identify trends, assess financial performance, and provide insights to improve revenue cycle management and prior authorization functions.
Serves as the communication hub for the prior authorization team coordinating payor, process, and overall departmental updates
Utilize technical expertise in the system to investigate and analyze insurance payor requirements for prior authorization, ensuring compliance and streamlined approvals.
Collaborate cross-functionally with Market Access, Sales, and Billing Strategy teams to align on prior authorization processes, optimize reimbursement strategies, and enhance overall patient access.
Conduct data analysis on team production, process improvements and workflow changes, in order to deliver insights on impacts related to workload volume, headcount planning, forecasted revenue, etc.
Assists with feedback for hiring, discipline and performance evaluations.
Provides department orientation and ongoing training for all in/direct reports.
Liaison with internal departments to promote ongoing communication, and collaboration on cross functional projects related to prior authorization.
Analyzes prior authorization outcomes from all sources, including carrier reimbursement exception reporting and follow up pending prior authorization analysis and denials management.
Represent organizational projects and assist management with follow-through and implementation of initiatives.
Manage all aspects of the prior authorization department including the timely, accurate submission and collection of all patient and customer accounts.
Works with across departments to manage the entire process from insurance verification to final collection.
Responsible for the timely accurate submission of all prior authorizations for service to the responsible payer.
Ensure that all payers needing prior authorization are set up correctly within the software system.
Monitors and validates adherence to Policies and Procedures, auditing as necessary. Monitors and evaluates employee productivity and performance to goal.
Builds employee morale, motivation and loyalty by fostering positive working relationships.
This role works with PHI on a regular basis both in paper and electronic form and have an access to various technologies to access PHI (paper and electronic) in order to perform the job.

QUALIFICATIONS:

Bachelor's Degree in related field, or equivalent years of professional experience required
Minimum of 3 years of experience in managing a high volume, fast growing billing team; within the laboratory setting is preferred.
Extensive knowledge of reimbursement, billing, coding, prior authorizations and compliance regulations is required.

KNOWLEDGE, SKILLS, AND ABILITIES:

Training in fields such as business administration, accountancy, computer sciences or similar vocations.
Normally requires a minimum of two (2) years directly related and progressively responsible experience within Revenue Cycle and Prior Authorizations
Ability to perform complex analysis and discuss with upper management.
Skilled in Microsoft Office: Word and Excel (advanced)
Ability to communicate effectively both orally and in writing.
Strong interpersonal skills, organizational skills, including attention to detail.
Extensive knowledge of payer authorization requirements
Health care research and analysis skills sufficient to support payer research healthcare policy library and state management.
Ability to resolve associate issues effectively and efficiently.

#LI-AB1

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: