Prior Authorization Representative I

Overview

This position is primarily remote work, but candidate must reside within the state of Utah for this one.

Top candidates will also have some prior working experience in Prior Authorizations.

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

This position is responsible to secure outpatient accounts by performing insurance verification, obtaining benefit information, calculating patient estimates, and obtaining prior authorization before services are rendered. This position works with physicians, nurses, clinic managers, and financial advocates to resolve issues that arise during the prior authorizations process. This position is not responsible for providing care to patients.

Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.

Responsibilities

Essential Functions

• Verifies insurance eligibility, benefits, network status, and creates pre-service liability estimate.
• Ensures accurate ICD, CPT codes and related medical records are submitted in the authorization request.
• Secures prior authorizations for outpatient imaging and in office scheduled services.
• Acts as a liaison between the payer and clinic schedulers/medical support staff.
• Follows up on delayed or denied authorization requests and escalates for resolution.
• Creates detailed documentation and maintains/stores the authorization paper trail.
• May work to resolve claims denials related to the prior authorization.

Knowledge / Skills / Abilities

• Basic knowledge of accounting, word processing, and spreadsheets.

• Demonstrated critical thinking and ability to analyze information and problem solve.

• Demonstrated professional verbal/written communication skills.

• Ability to work independently within a team setting.

• Ability to adapt to a dynamic work environment.

• Demonstrated ability to prioritize and manage a large workload in stressful situations.

• Ability to multitask.

• Familiarity with human anatomy and medical terminology.

• Demonstrated ability to complete work with a high level of detail and accuracy.

• Ability to meet process time standards.

• Ability to provide professional and courteous service in all interactions with internal and external customers.

• Ability to navigate through various hospital software applications, including Epic ADT/Prelude, Cadence, Epicare, Referrals and Auth/Cert applications.

• Ability to navigate and maneuver through multiple web sites.

Qualifications

Required

• Two years of experience in a health care financial setting, or the equivalency.

Qualifications (Preferred)

Preferred

• Previous experience with medical insurance and prior-authorizations.
• ICD/CPT coding experience.
• Outpatient or Radiology prior authorizations experience.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull, or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements