About Natera

Natera is a global leader in cell-free DNA testing and genetic diagnostics, committed to transforming healthcare through innovation and compassion. The Revenue Cycle Management team plays a crucial role in this mission—ensuring that patients receive access to life-changing testing while maintaining operational and financial excellence.

Position Summary:

The Manager, Prior Authorizations (Submissions Team) leads Natera’s Prior Authorization (PA) Submissions function, ensuring accurate, timely, and compliant submission of prior authorization requests across the company’s testing portfolio. This leader oversees a high-volume, metrics-driven operation that is critical to revenue capture and payor compliance.

The role involves managing daily production workflows, developing staff, and partnering cross-functionally to improve turnaround times, reduce denials, and enhance overall revenue cycle performance. The ideal candidate combines operational discipline, data-driven decision-making, and strong leadership in payor policy navigation and healthcare reimbursement processes.

Key Responsibilities:

Operational Leadership

• Oversee daily operations of the Prior Authorization Submissions team, ensuring that all requests are processed accurately and within defined turnaround times (TAT).

• Monitor and optimize team productivity and quality performance, ensuring adherence to departmental KPIs (≥95% accuracy; daily volume targets).

• Manage queue prioritization, workload balancing, and escalation handling for complex or high-priority cases.

• Evaluate authorization trends, payor turnaround times, and process adherence.

Workflow Optimization & Compliance

• Develop and maintain standard operating procedures (SOPs) for submission workflows, ensuring alignment with payor-specific requirements and regulatory compliance (HIPAA, PHI).

• Collaborate with internal stakeholders to minimize downstream claim denials and ensure end-to-end process integrity.

• Identify automation and technology enhancement opportunities to streamline processes and improve efficiency.

Team Management & Development

• Recruit, train, and develop a team of Prior Authorization Supervisors and Specialists; provide coaching, feedback, and performance evaluations.

• Foster a positive, inclusive, and high-performance culture that supports accountability, continuous learning, and operational excellence.

• Conduct quality audits and case reviews to ensure compliance with payor policy standards and internal quality metrics.

• Recognize and celebrate team performance milestones, driving engagement and retention.

Performance Analytics & Continuous Improvement

• Track and analyze team performance data, including submission volumes, approval rates, and denials.

• Create and distribute monthly trend reports summarizing operational KPIs and payor-specific insights.

• Partner with the RCM Analytics team to design dashboards for real-time productivity and quality tracking.

• Serve as a subject-matter expert on payor utilization management policies, ensuring the team remains current with evolving requirements.

Required Knowledge, Skills, and Abilities:

• Strong understanding of medical billing workflows, payor authorization systems, and revenue cycle operations.

• Expertise in medical necessity criteria and payor-specific prior authorization requirements.

• Proven ability to analyze operational data, identify performance gaps, and implement corrective actions.

• Excellent communication, leadership, and problem-solving skills.

• Experience working with Business Process Outsourcing (BPO) teams.

• Proficiency with Google Workspace and other RCM workflow tools.

Qualifications:

• Bachelor’s degree in Healthcare Administration, Business, or related field, or equal years of relevant professional experience.

• 5+ years of experience in Revenue Cycle Management or healthcare operations, with at least 2 years in prior authorization management or payor policy leadership.

• Demonstrated success leading high-performing, metric-driven teams in a large-scale healthcare or laboratory setting.

• Knowledge of HIPAA compliance, PHI handling, and payor-specific utilization management guidelines.

• Experience implementing process automation or digital transformation initiatives is a plus.

• PowerBI and Salesforce experience preferred.