Prior Authorization Representative I

About the role

This position is primarily remote work, but the candidate must reside within the state of Utah. University of Utah Health is a patient-focused organization dedicated to enhancing health and well-being through patient care, research, and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect.

Responsibilities

• Verifies insurance eligibility, benefits, network status, and creates pre-service liability estimates.
• 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.

Requirements

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

Preferred Qualifications

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

Working Conditions and Physical Demands

This is a sedentary position that may exert up to 10 pounds and may involve lifting, carrying, pushing, pulling, or otherwise moving objects. The role primarily involves sitting most of the time and is not exposed to adverse environmental conditions.

• Listening
• Sitting
• Speaking