Prior Authorization Rep II

University Medical Billing (UMB) is a fully remote department that is viewed as the premier billing office for the University of Utah School of Medicine, serving over 1,800 providers and 30 different specialties across Utah and surrounding states. We strive to be a great place to work while providing the best service to our customers. Our leaders and employees value collaboration, innovation, and accountability, and believe a successful candidate will exemplify these attributes too.

About the role

This is a career-development position within the field, requiring a moderate skill set and developing proficiency. The role is fully remote but requires adherence to UMB’s Telecommuting Agreement, including a distraction-free and HIPAA-compliant workspace, cameras on for all virtual calls/meetings, and the ability to work during assigned office hours (Monday–Friday, 8:00 AM–5:00 PM Mountain Time) regardless of time zone. New hires must provide their own monitors (two) and reliable internet service.

Employment is contingent on the successful completion of a background check.

Responsibilities

• Contact insurance companies for patient eligibility, benefits, network status, pre-service price estimates, and authorization.
• Update patient registration with insurance information.
• Follow up on delayed or denied authorization requests and escalate for resolution.
• Facilitate provider and insurance medical director reviews for medical determination of authorization.
• Maintain familiarity with contracts, payer guidelines, and resources to determine appropriate coverage and eligibility.
• Ensure accurate ICD and CPT codes and related medical records are submitted in authorization requests.
• Resolve claims denials related to prior authorization as needed.
• Review and summarize pre-authorization criteria for medical necessity to aid departments with procedure scheduling and/or financial advocate needs.
• Create and maintain detailed documentation of authorization history.
• Serve as a liaison between the payer and clinic schedulers/medical support staff.
• Complete other duties as assigned to support the team and department.

Requirements

• Three years of experience in a health care financial setting, or equivalency (one year of education can substitute for two years of related work experience).
• Six months of experience as a Prior Authorization Representative I or equivalent prior-authorization experience.

Qualifications

• Previous experience with insurance and prior authorizations.
• ICD/CPT Coding Certification.
• Inpatient and day surgery prior authorizations experience.
• Three years of experience in a medical setting.
• Two years of experience working prior authorizations, including:
  • Evaluation of medical necessity criteria for authorization.
  • Review of submitted requests for accuracy and completeness.
  • Monitoring pending authorizations and follow-up as needed.

Pay

$25–$28 per hour, depending on experience. Members of UMB are eligible for a bonus based on department performance.

Schedule

Full-time (40 hours per week), Monday–Friday, 8:00 AM–5:00 PM Mountain Time.

Benefits

• 90% employer-paid medical insurance.
• 14.2% retirement contribution.
• Reduced tuition.
• Paid time off (PTO) and holiday pay.