Prior Authorization Representative II

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

Job summary

A leading university's medical billing department seeks a Prior Authorization Representative II to ensure the efficiency of prior authorization processes. Responsibilities include training staff and auditing workflows, with a focus on collaboration and accountability. Ideal candidates will possess prior authorization experience and a commitment to quality service.

Benefits

90% employer-paid medical insurance

14.2% retirement contribution

Reduced tuition

PTO and holiday pay

Qualifications

• Three years of experience in a health care financial setting or equivalent.
• Six months of experience as a Prior Authorization Rep I or equivalent.

Responsibilities

• Audit internal and external staff on all workflows within Pre-Auth and Authorization Denials.
• Provide training and presentations on authorization procedures.
• Identify and summarize authorization concerns to supervisors.

Skills

Auditing

Training

Analysis

Education

Three years in a health care financial setting

Job description

Details

Open Date 06/13/2025

Requisition Number PRN42190B

Job Title Prior Authorization Representative II

Working Title Prior Authorization Representative II

Job Grade UGR

FLSA Code Nonexempt

Patient Sensitive Job Code? No

Standard Hours per Week 10

Full Time or Part Time? Full Time

Shift Day

Work Schedule Summary

UMB Office Hours; M-F 8:00am to 5:00pm Mountain Time

VP Area U of U Health - Academics

Department 00209 - Univ Medical Billing - Oper

Location Other

City Other

Type of Recruitment External Posting

Pay Rate Range $29-$32 per hour

Close Date 07/04/2025

Priority Review Date (Note - Posting may close at any time) 07/04/2025

Job Summary

University Medical Billing ( UMB ) is a fully remote department that is viewed as the premier billing office for the University of Utah School of Medicine, serving over 1,800 providers and 30 different specialties across Utah and surrounding states. We strive to be a great place to work while providing the best service to our customers. Our leaders and employees value collaboration, innovation, and accountability – attributes a successful candidate will exemplify.

As the Prior Authorization Representative Senior , you will be responsible for training and auditing internal and external staff in the prior and denials workflows. This position is not responsible for providing care to patients.

Employment is contingent on the successful completion of a background check and the adherence to departmental policies, including UMB’s Telecommuting Agreement which requires a distraction-free and HIPAA compliant workplace, cameras on for all virtual calls/meetings, and the ability to work during office hours or assigned shift (M-F, approximately 8am to 5pm Mountain Time) regardless of what time zone you live in. Additionally, new hires are required to provide their own monitors (two) and reliable internet service.

Compensation & Benefits

The starting salary for this position is $29 to $32 per hour, depending on experience. Members of UMB are eligible for a bonus based on department performance. All team members are eligible for the University’s comprehensive benefit package that includes 90% employer-paid medical insurance, a generous 14.2% retirement contribution, reduced tuition, PTO and holiday pay, and more.

Employment is contingent on the successful completion of a background check and the adherence to departmental policies, including UMB’s Telecommuting Agreement which requires a distraction-free and HIPAA compliant workplace, cameras on for all virtual calls/meetings, and the ability to work during office hours or assigned shift (M-F, approximately 8am to 5pm Mountain Time) regardless of what time zone you live in. Additionally, new hires are required to provide their own monitors (two) and reliable internet service.

Responsibilities

Essential Functions

1. Audit internal and external staff on all workflows within Pre-Auth and Authorization Denials.

2. Provide training and presentations to others on authorization procedures and practices, one on one or in group settings.

3. Responsible for identifying and summarizing authorization concerns and communicating to supervisors and managers.

4. Conduct high-level analysis of reports; provide feedback and recommendations to aid in reduction of denials.

5. Quality Review for business associate team to provide education and report of trends for accuracy improvement.

6. Manage policy, procedure, and workflow updates.

7. Meets productivity and accuracy expectations of the position.

8. Other duties as assigned.

This job description is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job.

Minimum Qualifications

Required

Three 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).

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

Preferred

Previous experience with insurance and prior authorizations.

ICD / CPT Coding Certification.

Inpatient and day surgery prior authorizations experience.

Preferences

An especially qualified candidate will also possess the following:

• Four years of experience in a health care financial setting.

• Two years of prior authorization experience, including robust experience and understanding of prior authorization workflows and authorization denials.

• Ability to train and audit internal and external staff.

• ICD / CPT Coding Certification.

Disclaimer

This job description has been designed to indicate the general nature and level of work performed by employees within this classification. It’s not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job.

Type Benefited Staff

Special Instructions Summary

While UMB is a remote department and this role will be performed remotely, interested applicants should note the following:

1. This role is expected to work during UMB office hours which are Monday through Friday, 8am to 5pm Mountain Time.

2. The University of Utah is committed to providing jobs to individuals located in Utah, and sees remote roles like this as an opportunity to provide amazing employment opportunities to those living in remote areas of the state. As such, Utah-based applicants may be prioritized in the screening process.

3. At this time, the University of Utah is unable to employ individuals living in California, Colorado, New York, Oregon, or Washington.

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. 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 University Human Resource Management 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.

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. 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 or 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 and Affirmative Action ( OEO /AA). More information, including the Director/Title IX Coordinator’s office address, electronic mail address, and telephone number can be located at: https://www.utah.edu/nondiscrimination/

Online reports may be submitted at oeo.utah.edu

https://safety.utah.edu/safetyreport This report includes statistics about criminal offenses, hate crimes, arrests and referrals for disciplinary action, and Violence Against Women Act offenses. They also provide information about safety and security-related services offered by the University of Utah. A paper copy can be obtained by request at the Department of Public Safety located at 1658 East 500 South.