Supervisor, Prior Authorization Strategy & Policy

 

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