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Company Name : University of Utah
Location : Salt Lake City, UT 84112
Position : Prior Authorization Representative II
Job Description : Announcement
Details
Open Date
03/28/2022
Requisition Number
PRN29891B
Job Title
Prior Authorization Representative II
Working Title
Job Grade
UGR
FLSA Code
Nonexempt
Patient Sensitive Job Code?
No
Standard Hours per Week
40.0
Full Time or Part Time?
Full Time
Shift
Day
Work Schedule Summary
as arranged
VP Area
U of U Health – Academics
Department
00209 – Univ Medical Billing – Oper
Location
Other
City
Salt Lake City, UT
Type of Recruitment
External Posting
Pay Rate Range
$23.00 – $28.00
Close Date
Open Until Filled
No
Job Summary
REMOTE WORK OPPORTUNITY. 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.
Responsibilities
Essential Functions.
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.
5. Requires critical thinking to determine what each individual payer requires to authorize the visit.
6. Acts as a liaison between the payer and clinic schedulers/medical support staff
7. Maintaining email resource and internal log and working closely with supervisors and managers.
8. Ability to work on other tasks while on long hold times with payer for authorization for another patient
9. 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.
10. Verifies insurance eligibility, benefits, network status to create pre-service price estimates for insured patients.
11. Creates and maintains detailed documentation of the authorization/notification trail.
12. Meets productivity and accuracy expectations of the position.
13. Overtime may be required.
14. Other duties may be required.
Problem Solving
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.
Minimum 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.
Preferred
Previous experience with insurance and prior authorizations.
ICD/CPT Coding Certification.
Inpatient and day surgery prior authorizations experience.
Preferences
Type
Benefited Staff
Special Instructions Summary
Additional Information
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.
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 or 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:
Director/ Title IX Coordinator
Office of Equal Opportunity and Affirmative Action (
OEO
/AA)
135 Park Building
Salt Lake City, UT 84112
801-581-8365
oeo@utah.edu
Online reports may be submitted at
oeo.utah.edu
To inquire about this posting, email:
employment@utah.edu
or call 801-581-2300.
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.
This post is listed Under Utah jobs
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