Coordinator, Prior Authorization

Job Summary

The Division of Pediatric Clinical Enterprise at the University of Utah School of Medicine has an immediate opening for a Scheduling and Prior Authorization Coordinator. This position works with a team of professionals responsible for obtaining prior authorization before services are rendered for requested procedures, testing, and medications. Responsibilities also include the coordination and scheduling of certain procedures and tests. This position works with physicians, nurses, clinic managers and financial advocates to resolve issues that arise during the prior authorizations process.

A high level of computer literacy for daily navigation through multiple electronic systems, trouble shooting, and completion of tasks is necessary. This position is team‐based where excellent communication and collaboration are vital components for completing responsibilities in an efficient and timely manner.

Responsibilities

1. Verifies insurance eligibility, benefits, and network status.
2. Ensures accurate ICD, CPT codes and related medical records are submitted in the authorization request.
3. Obtains pre‐authorization and referrals from insurance companies for diagnostic testing, procedures, treatments, and medication as ordered by healthcare providers.
4. Follows up on delayed or denied authorization requests and escalates for resolution.
5. Creates detailed documentation and maintains/stores the authorization paper trail.
6. Depending on the area of assignment, coordinates schedules for surgery and surgical procedures, testing and other services as requested and in accordance with departmental policy and procedures.
7. Effectively work with other team members in order to complete tasks efficiently and collaboratively.
8. Participates in quality improvement projects by developing data collection tools, analyzing, compiling and reporting data, and providing input to the QI process.