Associate Revenue Cycle Analyst – Prior Authorizations

Role Overview

• Inventory Diagnostic & Management: Actively monitors the PA work to identify inventory volume, aging trends, and 'stuck' requests. Determines necessary interventions to move files forward and maintain SLA compliance.
• PA Submission Integrity: Serves as the operational analyst for the submission workflow, ensuring that all upstream data is complete and accurate before submission.
• Cross-Functional Collaboration: Partners with Market Access to align on payor policies and works with Claims/Denials teams to bridge the gap between authorization feedback and actual payment outcomes.
• Anomaly Investigation: Performs deep-dive investigations into payer and vendor discrepancies and recommends system logic or workflow adjustments.
• Requirements & Documentation Management: Identifies and documents specific PA job requirements to ensure submissions are "right the first time."
• Root-Cause Trend Analysis: Conducts analysis on PA delays or submission failures, presenting actionable findings to leadership to drive continuous performance improvement.
• Workflow & Tracking Development: Assists in building and refining tracking tools and standardized workflows for the PA lifecycle.
• Vendor Monitoring: Reviews vendor performance and output, ensuring external partners accurately process actions and adhere to the organization’s high standards for reimbursement accuracy.
• KPI Reporting: Tracks and reports on key metrics, including Submission Turnaround Time (TAT), inventory 'bottleneck' age, vendor error rates, etc.
• Strategic Communication: Acts as a liaison for management to explain complex operational trends, system glitches, or payer-behavior shifts affecting the revenue cycle.
• Knowledge Sharing: Serves as a technical resource for internal teams regarding PA submission nuances and best practices for process improvement.

Requirements

• Education: Bachelor’s Degree in Business, Healthcare Administration, or a related field (or equivalent professional experience).
• Experience: 2–4 years of experience in healthcare revenue cycle, with a specific focus on prior authorization analysis, medical billing, or inventory management.
• Inventory Mastery: Advanced ability to manage high-volume inventory and identify specific points of failure or stagnation within a process.
• Technical Problem Solving: Strong critical thinking skills to troubleshoot logic errors and discrepancies between payor responses and internal routing rules.
• Data Proficiency: High proficiency in Microsoft Excel/Google Sheets (VLOOKUPs, Pivot Tables, Data Visualization).
• Collaborative Mindset: Ability to influence and work effectively across diverse teams.
• Analytical Communication: Ability to translate complex data into clear, concise reports for stakeholders at all levels.
• Nuanced Accuracy: Deep understanding of medical terminology and procedure coding as it relates to payor-specific submission requirements.
• Discretion: Strict adherence to HIPAA and confidentiality protocols regarding sensitive patient and financial data.

Benefits

• 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!