Prior Authorization Rep II

About the role

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.

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 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.