Associate Revenue Cycle Analyst, Prior Authorizations

Position Overview:
This role is pivotal in analyzing and resolving escalated prior authorization cases, and driving continuous revenue cycle improvements through data-driven insights. You will manage escalated cases, negotiate payment requests and appeals with payers, and leverage advanced data analysis skills to optimize our revenue cycle performance. Your expertise with payer portals, Excel (pivot tables, VLOOKUPS, etc.), and PowerBi will be critical in developing robust strategies and actionable reporting that lead to appropriate payments.

Key Responsibilities:

• Escalation & Case Resolution:
  
• Analyze and resolve escalated prior authorization cases by identifying root causes and implementing effective solutions.
  
• Data Analysis & Reporting:
  
• Perform detailed trend analysis on escalated cases and prior authorizations, presenting opportunities for performance improvement.
  
• Utilize advanced Excel functions (pivot tables, VLOOKUPS, etc.) to compile, organize, and analyze large data sets.
  
• Create and maintain interactive dashboards in PowerBi, tracking key metrics and identifying emerging trends.
  
• Workflow & Process Improvement:
  
• Assist in developing and refining workflows that enhance the efficiency of the designated revenue cycle function.
• Assist with building, designing, maintaining team job aids/SOP's/resources
  
• Lead weekly meetings to review key performance metrics, workflow efficiencies, trends, and performance improvement opportunities.
  
• Collaborate with cross-functional teams—including vendor operations and management—to ensure seamless operations and optimal reimbursement processes.
  
• Cross-Departmental Collaboration & Knowledge Sharing:
  
• Serve as a subject matter expert for the designated revenue cycle function, offering insights and best practices on performance improvement and escalated case resolution.
  
• Continually monitor prior authorization trends and requirements; research and interpret industry guidance to inform departmental strategies.
  
• Act as an educator, sharing knowledge on performance improvement methodologies and emerging technologies with related teams and departments.
  

Qualifications:

• Education & Experience:
  
• Bachelor’s Degree in Business or Healthcare Administration, or equivalent years of relevant professional experience.
  
• 2-3+ years of experience in medical billing, insurance collections, or revenue cycle management, with proven experience handling escalated prior authorization cases.
  
• Technical & Analytical Skills:
  
• Advanced proficiency in Microsoft Excel (pivot tables, VLOOKUPS, etc.) and PowerBi.
  
• Experience navigating various payer portals and understanding of their functionalities.
  
• Familiarity with medical billing systems, basic procedure coding (CPT/HCPCS, ICD-10, modifiers, and UB revenue codes), and medical terminology.
  
• Strong analytical skills with the ability to identify trends and articulate findings clearly and concisely.
  
• Interpersonal & Organizational Skills:
  
• Excellent verbal and written communication skills.
  
• Strong organizational, problem-solving, and critical thinking abilities.
  
• Ability to manage multiple priorities simultaneously while maintaining attention to detail.
  
• Demonstrated team player with a proactive, solution-oriented approach.
  

Why Join Us?
At Natera Inc., you will be part of an innovative team dedicated to transforming healthcare through advanced diagnostics and technology. This role offers a unique blend of case management, data analysis, and strategic process improvement—providing a dynamic and challenging work environment where your insights directly impact patient outcomes and organizational success.

If you are a driven professional with a passion for solving complex challenges through data and operational excellence, we invite you to apply and contribute to our mission of delivering cutting-edge healthcare solutions.