Prior Authorization Rep II

University Medical Billing (UMB) is a fully remote department that serves as the premier billing office for the University of Utah School of Medicine, supporting over 1,800 providers and 30 different specialties across Utah and surrounding states. We value collaboration, innovation, and accountability, and seek a candidate who embodies these attributes.

About the role

As the Prior Authorization Representative, you will ensure accounts by performing insurance verification, obtaining benefit information, calculating patient estimates, and securing prior authorization before services are rendered. This role collaborates with physicians, nurses, clinic managers, and financial advocates to resolve issues during the prior authorizations process. This is a career-development position requiring a moderate skill set and developing proficiency within the discipline.

Employment is contingent on a successful background check and adherence to departmental policies, including UMB's Telecommuting Agreement. This agreement requires a distraction-free, HIPAA-compliant workspace, cameras on for all virtual calls/meetings, and the ability to work during assigned shifts (Monday–Friday, approximately 8am to 5pm Mountain Time), regardless of your time zone. New hires must provide their own monitors (two) and reliable internet service.

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, 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 assist departments with procedure scheduling and financial advocate needs.
• Create and maintain detailed documentation of authorization history.
• Serve as a liaison between payers and clinic schedulers/medical support staff.
• Complete other duties as assigned to support the team and department.

Requirements

• Three years of experience in a healthcare 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

Preferred qualifications include:

• Previous experience with insurance and prior authorizations.
• ICD/CPT Coding Certification.
• Inpatient and day surgery prior authorizations experience.

An especially qualified candidate will also possess:

• 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.

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

Pay

The starting salary for this position is $25–$28 per hour, depending on experience. Members of UMB are eligible for a bonus based on department performance.

Benefits

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

Schedule

Full-time, remote position working UMB office hours: Monday–Friday, 8:00am to 5:00pm Mountain Time. Utah-based applicants may be prioritized, and the University is currently unable to employ individuals living in California, Colorado, New York, Oregon, or Washington.