University of Utah Health Care

  • Prior Authorization Rep II

    Requisition Number
    29926
    Reg/Temp
    Regular
    Employment Type
    Full-Time
    Shift
    Day
    Work Schedule
    Monday-Friday
    Location Name
    Business Services Building
    Patient Care?
    No
    City
    SALT LAKE CITY
    State
    UT
    Department
    COR ISC 10D PAT ACCESS NOVA
    Category
    Other
  • 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, diversity, integrity, quality and trust that are integral to our mission. EO/AA

    For use in RCSS only.

    Responsible to secure outpatient accounts by performing insurance verification, obtain benefit information, calculating patient estimates and obtain 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.

    Responsibilities

    • 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 services such as scheduled day surgeries, planned inpatient admissions, urgent admissions and air transport. Responsible to financially secure over $2 billion in patient revenue annually.
    • Acts as a liaison between the payer, medical support staff and providers in the event 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 the 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

    Qualifications

    Required

    • Three years’ experience in a health care financial setting or equivalency.
    • Six months or more 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.

    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

    Sitting, Standing

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