Prior Authorization Rep II

Utah; Salt Lake City, Northern (UT, KY); Hybrid; USD 54,000 - 72,000; Full time

Job summary

University of Utah Health Hospitals and Clinics in Salt Lake City is seeking a Prior Authorization Specialist to secure outpatient accounts by verifying insurance, obtaining benefit information, calculating patient estimates and securing prior authorization before services.

You will collaborate with physicians, nurses, clinic managers and financial advocates to resolve authorization issues, maintain the documentation trail, and support case management workflows to ensure timely authorizations.

Qualifications

• Three years of experience in a health care financial setting.
• Six months of experience as a Prior Authorization Rep I or equivalent prior-authorization experience.
• Preferred: ICD/CPT Coding Certification.

Responsibilities

• Verify insurance eligibility, benefits, and network status to create pre-service price estimates.
• Secure prior authorization for high-dollar and complex services.
• Follow up on delayed or denied authorization requests and escalate for resolution.
• Maintain detailed documentation of the authorization trail.

Skills

Communication skills

Deadline orientation

Organization

Customer service

Detail-oriented

Job description

Overview

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 to create pre-service price estimates for insured patients.


• Ensures accurate ICD, CPT codes and related medical records are submitted in the authorization request. Requires critical thinking to determine what each individual payer requires to authorize the visit.


• Secures prior authorization for high dollar and complex services, which may include day surgeries, planned inpatient admissions, and high-end ancillary services. Responsible for the financial security of billions of dollars of gross revenue annually.


• Acts as a liaison between the payer, medical support staff, and providers in the event that additional medical records are required to authorize.


• Follows up on delayed or denied authorization requests and escalates for resolution. Facilitates provider and insurance medical directors reviews for medical determination if the visit should be authorized.


• Creates and maintains detailed documentation of the authorization/notification trail.


• Drives critical dependent workflows such as for case managers/utilization review to ensure length of stay authorization is secured.


• Ability to work on other tasks while on long hold times with payer for authorization for another patient.

Knowledge / Skills / Abilities

• Demonstrated ability to provide clear and professional written/verbal communication skills.


• Ability to meet deadlines for projects, tasks, and goals as assigned.


• Ability to organize and prioritize work to meet productivity expectations.


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


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


• Demonstrated accountability for work taking ownership for quality and timeliness of work.


• Ability to work independently within a team setting.


• Consistently demonstrates positive attitude when interacting with team members.


• Ability to resolve difficult or complicated challenges in a logical manner and provide recommendations for resolution.


• Ability to prioritize and multitask.

Qualifications

Required

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


• Six months of experience as a Prior Authorization Rep I or equivalent prior-authorization experience.

Qualifications (Preferred)

Preferred

• Previous experience with insurance and prior authorizations.


• ICD/CPT Coding Certification.


• Inpatient and day surgery 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

Listening, Sitting, Speaking

Multi-lingual Candidates Welcomed

EEO Statement

University of Utah Health Hospitals and Clinics, a part of The University of Utah, values candidates who have experience working in settings with students and patients from all backgrounds and possess a strong commitment to improving access to higher education and quality healthcare for historically underrepresented students and patient populations.

All qualified individuals are encouraged to apply. Veterans’ preference is extended to qualified applicants, upon request and consistent with University policy and Utah state law. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities.

University of Utah Health Hospitals and Clinics, a part of The University of Utah, is an Affimative Action/Equal Opportunity employer and does not discriminate based upon race, ethnicity, color, religion, national origin, age, disability, sex, sexual orientation, gender, gender identity, gender expression, pregnancy, pregnancy-related conditions, genetic information, or protected veteran's status. The University does not discriminate on the basis of sex in the education program or activity that it operates, as required by Title IX and 34 CFR part 106. The requirement not to discriminate in education programs or activities extends to admission and employment. Inquiries about the application of Title IX and its regulations may be referred to the Title IX Coordinator, to the Department of Education, Office for Civil Rights, or both. To request a reasonable accommodation for a disability, please contact the University of Utah Health Hospitals and Clinics Human Resources office at 801-581-6500. If you or someone you know has experienced discrimination or sexual misconduct including sexual harassment, you may contact the Director/Title IX Coordinator in the Office of Equal Opportunity (OEO). More information, including the Director/Title IX Coordinator's office address, electronic mail address, and telephone number can be located at: www.utah.edu/nondiscrimination/ Online reports may be submitted at oeo.utah.edu/

The University is a participating employer with Utah Retirement Systems ("URS"). Eligible new hires with prior URS service, may elect to enroll in URS if they make the election before they become eligible for retirement (usually the first day of work). Contact Hospitals and Clinics Human Resources at [phone] for information. Individuals who previously retired and are receiving monthly retirement benefits from URS are subject to URS’ post-retirement rules and restrictions. Please contact Utah Retirement Systems at [phone] or [phone] or Hospitals and Clinics Human Resources at [phone] if you have questions regarding the post-retirement rules.

This position may require the successful completion of a criminal background check and/or drug screen.

Requisition Number 86106
Reg/Temp Regular
Employment Type Full-Time
Shift Day
Work Schedule 8am - 16:30
Clinical/Non-Clinical Status Non-Clinical
Location Name Business Services Building
Workplace Set Up Remote
City SALT LAKE CITY
State UT
Department COR ISC 10D PAT ACCESS NOVA
Category Finance/Accounting
Workplace Set Up Remote