Prior Authorization Representative I - University of Utah Health
SALT LAKE CITY, UT
About the Job
Overview
This position is primarily remote work, but candidate must reside within the state of Utah for this one.
_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_
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.
Top candidates will also have some prior working experience in Prior Authorizations.
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, and creates pre-service liability estimate.
+ Ensures accurate ICD, CPT codes and related medical records are submitted in the authorization request.
+ Secures prior authorizations for outpatient imaging and in office scheduled services.
+ Acts as a liaison between the payer and clinic schedulers/medical support staff.
+ Follows up on delayed or denied authorization requests and escalates for resolution.
+ Creates detailed documentation and maintains/stores the authorization paper trail.
+ May work to resolve claims denials related to the prior authorization.
Knowledge / Skills / Abilities
+ Basic knowledge of accounting, word processing, and spreadsheets.
+ Demonstrated critical thinking and ability to analyze information and problem solve.
+ Demonstrated professional verbal/written communication skills.
+ Ability to work independently within a team setting.
+ Ability to adapt to a dynamic work environment.
+ Demonstrated ability to prioritize and manage a large workload in stressful situations.
+ Ability to multitask.
+ Familiarity with human anatomy and medical terminology.
+ Demonstrated ability to complete work with a high level of detail and accuracy.
+ Ability to meet process time standards.
+ Ability to provide professional and courteous service in all interactions with internal and external customers.
+ Ability to navigate through various hospital software applications, including Epic ADT/Prelude, Cadence, Epicare, Referrals and Auth/Cert applications.
+ Ability to navigate and maneuver through multiple web sites.
Qualifications
Qualifications Required
+ Two years of experience in a health care financial setting, or the equivalency.
Qualifications (Preferred)
Preferred
+ Previous experience with medical insurance and prior-authorizations.
+ ICD/CPT coding experience.
+ Outpatient or Radiology prior authorizations experience.
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
Listening, Sitting, Speaking
Multi-lingual Candidates Welcomed
_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 from diverse backgrounds and possess a strong commitment to improving access to higher education for historically underrepresented students._
_Individuals from historically underrepresented groups, such as minorities, women, qualified persons with disabilities and protected veterans 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._
_University of Utah Health Hospitals and Clinics, a part of The University of Utah, is an Affirmative Action/Equal Opportunity employer and does not discriminate based upon race, ethnicity, color, religion, national origin, age, disability, sex, sexual orientation, gender, gender identity, gender expression, pregnancy, pregnancy-related conditions, genetic information, or protected veteran's status. The University does not discriminate on the basis of sex in the education program or activity that it operates, as required by Title IX and 34 CFR part 106. The requirement not to discriminate in education programs or activities extends to admission and employment. Inquiries about the application of Title IX and its regulations may be referred to the Title IX Coordinator, to the Department of Education, Office for Civil Rights, or both._
_To request a reasonable accommodation for a disability, please contact the University of Utah Health Hospitals and Clinics Human Resources office at 801-581-6500. If you or someone you know has experienced discrimination or sexual misconduct including sexual harassment, you may contact the Director/Title IX Coordinator in the Office of Equal Opportunity and Affirmative Action (OEO/AA). More information, including the Director/Title IX Coordinator's office address, electronic mail address, and telephone number can be located at:www.utah.edu/nondiscrimination/_
_Online reports may be submitted atoeo.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 Hospitals and Clinics Human Resources at (801) 581-6500 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 Hospitals and Clinics Human Resources at (801) 581-6500 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._
Requisition Number _71157_
Reg/Temp _Regular_
Employment Type _Full-Time_
Shift _Day_
Work Schedule _8-4:30pm_
Clinical/Non-Clinical Status _Non-Clinical_
Location Name _Business Services Building_
Workplace Set Up _Remote_
_City_ _SALT LAKE CITY_
_State_ _UT_
Department _COR ISC 10D PAT ACCESS NOVA_
Category _Finance/Accounting_
Workplace Set Up _Remote_
This position is primarily remote work, but candidate must reside within the state of Utah for this one.
_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_
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.
Top candidates will also have some prior working experience in Prior Authorizations.
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, and creates pre-service liability estimate.
+ Ensures accurate ICD, CPT codes and related medical records are submitted in the authorization request.
+ Secures prior authorizations for outpatient imaging and in office scheduled services.
+ Acts as a liaison between the payer and clinic schedulers/medical support staff.
+ Follows up on delayed or denied authorization requests and escalates for resolution.
+ Creates detailed documentation and maintains/stores the authorization paper trail.
+ May work to resolve claims denials related to the prior authorization.
Knowledge / Skills / Abilities
+ Basic knowledge of accounting, word processing, and spreadsheets.
+ Demonstrated critical thinking and ability to analyze information and problem solve.
+ Demonstrated professional verbal/written communication skills.
+ Ability to work independently within a team setting.
+ Ability to adapt to a dynamic work environment.
+ Demonstrated ability to prioritize and manage a large workload in stressful situations.
+ Ability to multitask.
+ Familiarity with human anatomy and medical terminology.
+ Demonstrated ability to complete work with a high level of detail and accuracy.
+ Ability to meet process time standards.
+ Ability to provide professional and courteous service in all interactions with internal and external customers.
+ Ability to navigate through various hospital software applications, including Epic ADT/Prelude, Cadence, Epicare, Referrals and Auth/Cert applications.
+ Ability to navigate and maneuver through multiple web sites.
Qualifications
Qualifications Required
+ Two years of experience in a health care financial setting, or the equivalency.
Qualifications (Preferred)
Preferred
+ Previous experience with medical insurance and prior-authorizations.
+ ICD/CPT coding experience.
+ Outpatient or Radiology prior authorizations experience.
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
Listening, Sitting, Speaking
Multi-lingual Candidates Welcomed
_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 from diverse backgrounds and possess a strong commitment to improving access to higher education for historically underrepresented students._
_Individuals from historically underrepresented groups, such as minorities, women, qualified persons with disabilities and protected veterans 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._
_University of Utah Health Hospitals and Clinics, a part of The University of Utah, is an Affirmative Action/Equal Opportunity employer and does not discriminate based upon race, ethnicity, color, religion, national origin, age, disability, sex, sexual orientation, gender, gender identity, gender expression, pregnancy, pregnancy-related conditions, genetic information, or protected veteran's status. The University does not discriminate on the basis of sex in the education program or activity that it operates, as required by Title IX and 34 CFR part 106. The requirement not to discriminate in education programs or activities extends to admission and employment. Inquiries about the application of Title IX and its regulations may be referred to the Title IX Coordinator, to the Department of Education, Office for Civil Rights, or both._
_To request a reasonable accommodation for a disability, please contact the University of Utah Health Hospitals and Clinics Human Resources office at 801-581-6500. If you or someone you know has experienced discrimination or sexual misconduct including sexual harassment, you may contact the Director/Title IX Coordinator in the Office of Equal Opportunity and Affirmative Action (OEO/AA). More information, including the Director/Title IX Coordinator's office address, electronic mail address, and telephone number can be located at:www.utah.edu/nondiscrimination/_
_Online reports may be submitted atoeo.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 Hospitals and Clinics Human Resources at (801) 581-6500 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 Hospitals and Clinics Human Resources at (801) 581-6500 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._
Requisition Number _71157_
Reg/Temp _Regular_
Employment Type _Full-Time_
Shift _Day_
Work Schedule _8-4:30pm_
Clinical/Non-Clinical Status _Non-Clinical_
Location Name _Business Services Building_
Workplace Set Up _Remote_
_City_ _SALT LAKE CITY_
_State_ _UT_
Department _COR ISC 10D PAT ACCESS NOVA_
Category _Finance/Accounting_
Workplace Set Up _Remote_
Source : University of Utah Health
