Prior Authorization Representative I

University of Utah; Salt Lake City (UT); On-site; USD 60,000 - 80,000; Full time

Job description

Job Grade: UGR

FLSA Code: Nonexempt

Patient Sensitive Job Code? No

Standard Hours per Week: 40

Full Time or Part Time? Full Time

Shift: Day

Work Schedule Summary: Monday – Friday

VP Area: U of U Health - Academics

Department: 01455 - Dermatology Clinical Hpp

Location: Other

City: Salt Lake City, UT

Type of Recruitment: External Posting

Pay Rate Range: 19.27 - 25.49

Close Date: Open Until Filled

Job Summary

This position is responsible for securing 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.

This position is eligible for work from home and/or hybrid work options. Might be required to work onsite during the training period.

Responsibilities

Essential Functions:

• Verifies insurance eligibility, benefits, network status, and creates pre-service liability estimates.
• 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 websites.

Minimum Qualifications

Required: Two years of experience in a health care financial setting, or equivalency (one year of education can be substituted for two years of related work experience).

Preferred: Previous experience with medical insurance and prior authorizations, ICD/CPT coding experience, outpatient or radiology prior authorizations experience.

Additional Information

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 Human Resources at [phone] for information.

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

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 patients.

All qualified individuals are strongly 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.

The University of Utah is an Affirmative 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.