Remote Prior Authorization Specialist II

University of Utah Health; Salt Lake City (UT); On-site; USD 34,000 - 39,000; Full time

Job summary

University Medical Billing (UMB) is a fully remote department within University of Utah Health, serving numerous providers and specialties. We seek an experienced Prior Authorization Representative to verify insurance, obtain benefits, estimate patient costs, and obtain prior authorization before services.

Collaboration with physicians, nurses, and financial advocates is essential. Hybrid-friendly responsibilities include medical necessity reviews and maintaining authorization history while

Qualifications

• Three years of experience in a health care financial setting (or equivalency).
• Six months of experience as a Prior Authorization Rep I or equivalent prior-authorization experience.
• Preferred: ICD / CPT Coding Certification.
• Preferred: Inpatient and day surgery prior authorizations experience.
• Applicants must demonstrate potential ability to perform essential functions as outlined in the position description.

Responsibilities

• Contact insurance companies for patient eligibility, benefits, network status, pre-service price estimates, and authorization.
• Update patient registration with insurance information.
• Follow-up on delayed or denied authorization requests, elevate for resolution.
• Facilitates provider and insurance medical director’s reviews for medical determination if the visit should be authorized.
• Maintain familiarity with contracts, payer guidelines, and resources to determine appropriate coverage and eligibility.
• Ensures accurate ICD, CPT codes and related medical records are submitted in the authorization request.
• Resolve claims denials related to the prior authorization, as needed.
• Review and summarize pre-authorization criteria for medical necessity to aid departments with procedure scheduling and/or financial advocate needs.

Skills

Insurance verification

Prior authorizations

Healthcare billing

Communication with providers

Tools

ICD / CPT Coding Certification

Job description

University Medical Billing (UMB) is a fully remote department within University of Utah Health, serving numerous providers and specialties. We seek an experienced Prior Authorization Representative to verify insurance, obtain benefits, estimate patient costs, and obtain prior authorization before services.

Collaboration with physicians, nurses, and financial advocates is essential. Hybrid-friendly responsibilities include medical necessity reviews and maintaining authorization history while