[Remote] Eligibility and Prior Authorization Specialist

Note: The job is a remote job and is open to candidates in USA. Natera is a global leader in cell-free DNA testing, dedicated to oncology, women’s health, and organ health. The Eligibility and Prior Authorization Specialist plays a critical role in ensuring accurate insurance verification and timely prior authorization processing for testing services, contributing to operational efficiency and regulatory compliance.

Responsibilities

• 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.
• 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.
• 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.
• 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.

Skills

• 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.
• 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.

Benefits

• Comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents
• Free testing in addition to fertility care benefits
• Pregnancy and baby bonding leave
• 401k benefits
• Commuter benefits
• Generous employee referral program

Company Overview

• Natera specializes in cell-free DNA testing to provide a more targeted interventions to oncology, women's health, and organ health. It was founded in 2004, and is headquartered in San Carlos, California, USA, with a workforce of 5001-10000 employees. Its website is https://www.natera.com/.

Company H1B Sponsorship

• Natera has a track record of offering H1B sponsorships, with 64 in 2025, 72 in 2024, 37 in 2023, 71 in 2022, 64 in 2021, 40 in 2020. Please note that this does not guarantee sponsorship for this specific role.

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