Job Description

University of Utah Job Description

Job Summary

For use in RCSS only. 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.

Qualifications

Required

• Two years of experience in a health care financial setting, or the equivalency.

Preferred

• Previous experience with medical insurance and prior-authorizations.
• ICD/CPT coding experience.
• Outpatient or Radiology prior authorizations experience.

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

Disclaimer

This job description has been designed to indicate the general nature and level of work performed by employees within this classification.  It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job.

Essential Functions

• 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.

Problem Solving

• 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.

Comments