Prior Authorization Rep II

University Of Utah Health Outpatient Account Specialist

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, integrity, quality and trust that are integral to our mission.

This position is responsible to secure outpatient accounts by performing insurance verification, obtaining benefit information, calculating patient estimates and obtaining 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.

Corporate Overview : The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.

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 that 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

Qualifications

Required :

Preferred :

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

To inquire about this posting, email : careers@hsc.utah.edu

EEO Statement : University of Utah Health Hospitals and Clinics, a part of 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 patient populations. All qualified individuals are 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.