Prior Authorization Rep II

University Of Utah Health Position

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. 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.

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

Essential Functions

• 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 and complex services, which may include day surgeries, planned inpatient admissions, and high-end ancillary services. Responsible for the financial security of billions of dollars of gross 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

• 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 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

Required

• Three years of experience in a health care financial setting, or the equivalency.
• Six months of experience 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.
• Inpatient and day surgery 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