Prior Authorization and Payer Reimbursement Coordinator

Job Summary:

As a key member of the Revenue Cycle Team, the Prior Authorization and Payer Reimbursement Specialist (PAPR) at the CU Hemophilia and Thrombosis Center (HTC) is tasked with obtaining claim authorizations from payers for outpatient services and physician administered drugs while ensuring compliance with reimbursement requirements. This involves collecting demographic, insurance, and clinical information from patients and conducting insurance verification processes, including verifying patient eligibility, and coordinating medical benefits. The PAPR specifically consults with the HTC Clinical Team, the University of Colorado Medicine revenue cycle team, the HTC Specialty Pharmacy, and the HTC Finance Team to manage and maximize clinical revenues.

Key Responsibilities:

• Serve as principal contact and subject matter expert for HTC and/or department staff regarding prior authorization process for services rendered at both the HTC AMC and Outreach clinics.
• Obtain, review and input insurance authorization and referrals prior to patient services, and throughout treatment to maintain continuance of authorizations. Advocate for the patient, utilizing knowledge of coverage-based guidelines and treatments.
• In collaboration with CU Medicine, identify and provide accurate CPT/ICD codes where needed for reimbursement.
• Maintain appropriate logs and reports to professional, State and Federal requirements; including but not limited to Medicaid, Medicare, case logs, and drug logs as required.
• Follow up on denied authorization requests, escalate to appointed appeal personnel, and relay the necessary denial detail to the provider to support the appeal and/or peer-to-peer reviews.
• Serve as the primary resource to patients regarding the prior authorization process. Explain requirements, terminology, billing process, consent requirements, collect insurance info, etc., as necessary.
• Work closely with the Pharmacy Revenue Cycle Specialist to coordinate and maximize HTC reimbursements and provide backup coverage when absent from office.

Why Join Us:

The Hemophilia & Thrombosis Center (HTC) is an internationally renowned specialized disease management center for children and adults within the University of Colorado, School of Medicine.  The HTC provides direct comprehensive diagnostic and treatment services to over 3000 adult and pediatric patients with rare chronic bleeding and clotting disorders throughout a multiple-state region.   The Center encompasses a freestanding School of Medicine clinic, a

specialty pharmacy, research laboratories, clinical research services, professional training, patient education, and patient outreach and support programs.

The University of Colorado offers a comprehensive benefits package that includes health insurance, life insurance, retirement plans, tuition benefits, ECO pass, paid time off – vacation, sick, paid holidays, and more. To see what benefits are available, please visit: https://www.cu.edu/employee-services/benefits-wellness .

Diversity and Equity:

The University of Colorado Anschutz Medical Campus is committed to recruiting and supporting a diverse student body, faculty, and administrative staff. The university strives to promote a culture of inclusiveness, respect, communication, and understanding. We encourage applications from women, ethnic minorities, persons with disabilities, persons within the LGBTQ+ community, and all veterans. The University of Colorado is committed to diversity and equality in education and employment.

Qualifications:

Minimum Qualifications:

• A bachelor’s degree in business management or administration or a directly related field from an accredited institution.
  • Substitution: A combination of education and related technical/paraprofessional experience may be substituted for the bachelor’s degree on a year-for-year basis.
• At least five (5) years in this field or related field such as medical coding, financial counseling setting or similar service profession.

Applicants must meet minimum qualifications at the time of hire.

Preferred Qualifications:

• Strong knowledge of ICD9/10 diagnosis codes, as well as CPT codes.
• Knowledge/experience obtaining authorizations for Physician Dispensed Drugs (PDA) on a “buy and bill” basis.
• Knowledge of EPIC EMR authorization and referral processes.
• Previous “front office” outpatient clinic experience.
• Previous billing, public and private pay experience.
• Bilingual (English/Spanish).

Knowledge, Skills, and Abilities:

• Ability to communicate effectively, both in writing and orally in English and preferably Spanish.
• Ability to establish and maintain effective working relationships with employees at all levels throughout the institution.
• Outstanding customer service skills.
• Demonstrated commitment and leadership ability to advance diversity and inclusion.
• Ability to take direction and use independent judgment to coordinate various projects and meet multiple deadlines.

How to Apply:

For full consideration, please submit the following document(s):

1.     A letter of interest describing relevant job experiences as they relate to listed job qualifications and interest in the position

2.     Curriculum vitae / Resume

3.     Three to five professional references including name, address, phone number (mobile number if appropriate), and email address

Questions should be directed to: Steven Powell, [email protected]

Screening of Applications Begins:

Applications will be accepted until finalists are identified, but preference will be given to complete applications received by April 30, 2024. Those who do not apply by this date may or may not be considered.

Anticipated Pay Range:

The hiring range for this position has been established as $76,517 to $97,330.

The above hiring range represents the University’s good faith and reasonable estimate of the range of possible compensation at the time of posting. This position may be eligible for overtime compensation depending on the level.

Your total compensation goes beyond the number on your paycheck. The University of Colorado provides generous leave, health plans and retirement contributions that add to your bottom line.

Total Compensation Calculator: http://www.cu.edu/node/153125

ADA Statement:

The University will provide reasonable accommodations to applicants with disabilities throughout the employment application process. To request an accommodation pursuant to the Americans with Disabilities Act, please contact the Human Resources ADA Coordinator at [email protected] .

Background Check Statement:

The University of Colorado Anschutz Medical Campus is dedicated to ensuring a safe and secure environment for our faculty, staff, students, and visitors. To assist in achieving that goal, we conduct background investigations for all prospective employees.

Vaccination Statement:

CU Anschutz strongly encourages vaccination against the COVID-19 virus and other vaccine preventable diseases . If you work, visit, or volunteer in healthcare facilities or clinics operated by our affiliated hospital or clinical partners or by CU Anschutz, you will be required to comply with the vaccination and medical surveillance policies of the facilities or clinics where you work, visit, or volunteer, respectively. In addition, if you work in certain research areas or perform certain safety sensitive job duties, you must enroll in the occupational health medical surveillance program .