Prior Authorization Representative II

As Arranged

The Prior Authorization Specialist is responsible to secure outpatient and inpatient accounts by performing insurance verification, obtain benefit information, calculating patient estimates and obtain prior authorization before services are rendered. This position work with physicians, nurses, clinic managers, and financial advocates to resolve issues that arise during the prior authorization process.

This position is considered Category IIA: Not required on campus and has the ability to telework remotely for the duration of the University of Utah’s response to COVID-19. An employee hired into this role will be responsible for providing space, telephone, printing, networking and/or internet capabilities at the telecommute location and agree to the terms of the University of Utah campus and Health Academics COVID-19 Telecommuting Agreement.

1. Contacting insurances (by phone, e-mail and regular mail) for eligibility, benefits, network status and authorization, documenting information.
2. Reviews and summarizes pre-authorization criteria for medical necessity to aid departments with procedure scheduling and/or financial advocate needs.
3. Familiarity with contracts, payer guidelines, and resources to determine appropriate coverage and eligibility.
4. 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.
5. Acts as a liaison between the payer and clinic schedulers/medical support staff
6. Maintaining email resource and internal log and working closely with supervisors and managers.
7. Ability to work on other tasks while on long hold times with payer for authorization for another patient
8. 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.
9. Meets productivity and accuracy expectations of the position.
10. Overtime may be required.
11. Other duties may be required.

Work Environment and Level of Frequency typically required
Nearly Continuously: Office environment.
Physical Requirements and Level of Frequency that may be required
Nearly Continuously: Sitting, hearing, listening, talking.
Often: Repetitive hand motion (such as typing), walking.
Seldom: Bending, reaching overhead.

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. Knowledge of CPT, ICD9/10 and DRG codes.

Previous experience with medical insurance, prior-authorizations and ICD/CPT Coding experience preferred.

This position is not responsible for providing care to patients.

Applicants must demonstrate the potential ability to perform the essential functions of the job as outlined in the position description.

1. CPC Certification
2. Experience with insurance reimbursement and understanding of policies and benefit information, and the ability to give this information to patients, physicians and office staff.
3. Customer Service experience.
4. ICD/CPT Coding Certification

The University of Utah is an Affirmative Action/Equal Opportunity employer and is committed to diversity in its workforce. In compliance with applicable federal and state laws, University of Utah policy of equal employment opportunity prohibits discrimination on the basis of race or ethnicity, religion, color, national origin, sex, age, sexual orientation, gender identity/expression, veteran’s status, status as a qualified person with a disability, or genetic information. Individuals from historically underrepresented groups, such as minorities, women, qualified persons with disabilities, and protected veterans are strongly encouraged to apply. Veterans’ preference is extended to qualified applicants, upon request and consistent with University policy and Utah state law.
To inquire about this posting, email: employment@utah.edu or call 801-581-2300. Reasonable accommodations in the application process will be provided to qualified individuals with disabilities. To request an accommodation or for further information about University AA/EO policies, please contact the Office of Equal Opportunity and Affirmative Action, 201 S. Presidents Cr., Rm 135, (801) 581-8365 (V/TDD), email: oeo@umail.utah.edu .

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 (801) 581-7447 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 (801) 366-7770 or (800) 695-4877 or University Human Resource Management at (801) 581-7447 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.