Pre-Authorization Clerk - Full Time

Uintah Basin Medical Center; Roosevelt (UT); On-site; USD 35,000 - 48,000; Full time

Job summary

Uintah Basin Medical Center in Roosevelt, UT is seeking an on-site Prior Authorization Clerk. The role focuses on obtaining payer authorizations, collecting patient demographics and insurance details, and ensuring accurate EMR records for services rendered.

Compliance with HIPAA and organizational policies is essential. The successful candidate will verify insurance, coordinate with payers, and assist with referrals to financial counseling when needed, while maintaining professional

Qualifications

• Verifies patient insurance and benefits information.
• Obtains prior authorizations from third-party payers according to requirements.
• Collects demographic and insurance information from patients as needed.
• Maintains accurate authorization records in the EMR.
• Complies with HIPAA and organizational privacy policies.

Responsibilities

• Verify patient insurance and benefits details.
• Obtain prior authorizations from payers per requirements.
• Collect demographic and insurance information from patients.
• Update EMR with required data and authorizations.
• Collaborate with departments to gather clinical information for payer authorization.
• Post payments and support financial counseling when needed.
• Maintain accurate records of authorizations in the EMR.

Skills

Prior authorizations

EMR data entry

HIPAA compliance

Customer service

Multitasking

Tools

EMR/EHR

Job description

Uintah Basin Medical Cntr
Roosevelt, UT 84066, USA

• On-site
• Travel Required : No
• Full-Time
• Requisition #: PREAU002283

Description

Job Summary

The prior authorization clerk is responsible for ensuring that payers are prepared to reimburse Uintah Basin Healthcare for scheduled services in accordance with the payer-provider contract. The clerk contacts payers to request service authorization and may collect financial and/or demographic information from patients as needed. Identifies prearranged payment plans and follows instructions as outlined by the Patient Access Manager. Requests and collects self-pay balances per organizational guidelines.

Duties and Responsibilities

• Demonstrates Competency in the Following Areas:
• Verifies patient's insurance and benefits information.
• Obtains prior authorizations from third-party payers in accordance with payer requirements.
• Contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR as necessary.
• Works with other departments to gather the clinical information required by the payer to authorize services.
• Maintains accurate records of authorizations with EMR.
• Refers accounts to financial counseling as needed if authorization is not obtained.
• Works with business office staff to support appeal efforts for authorization-related denials.
• Complies with HIPAA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality.
• Maintains a professional tone at all times when communicating with patients and payer representatives.
• Performs all other duties as assigned by departmental leaders.
• Accurately and thoroughly collects, analyzes, and records demographic, insurance, financial, and clinical data in a computer system. Ensures the information source is appropriate.
• Updates and edits information in the computer system, ensuring that all fields are populated correctly and appropriately.
• Obtains information and completes Medicare Secondary Payer Questionnaire and other payer-specific documents as required.
• Posts payments within the billing system.
• Ensures that all monies collected are secured or turned over to appropriate associates.
• Refers patients to Financial Counselors for in-depth financial counseling.
• Ability to perform a variety of tasks, often changing assignments on short notice.
• Must be adept at multi-tasking.
• Readily identifies work that needs to be performed and completes it without needing to be told.

Professional Requirements

• Ensures that appearance and personal conduct are professional at all times.
• Excellent attendance record.
• Wears appropriate clothing for job functions. Wears ID badge.
• Works at maintaining a good rapport and a cooperative working relationship with physicians,administration, and staff.
• Represents the organization in a positive and professional manner in the community.
• Maintains patient confidentiality at all times.
• Complies with all organizational policies regarding ethical business practices.
• Exceptional organization and time management skills.

Travel Required

No .

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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