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

• 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.

This position is patient-sensitive and must fulfill all associated requirements. We protect our patients, coworkers and community by requiring all patient-sensitive employees to be immunized according to CDC standards and hospital policy. Limited exemptions may be made for documented medical contraindications or religious beliefs that object to vaccinations.

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 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.

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.

Comments

The staff member must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.  The individual must demonstrate knowledge of the principles of life span growth and development and the ability to assess data regarding the patient's status and provide care as described in the department's policies and procedures manual.