Prior Authorization Rep II
Job Summary
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.
We are looking for an experienced
Prior Authorization
Representative to join our team. As the Prior
Authorization Rep, you will be responsible for ensuring accounts by
performing insurance verification, obtaining benefit information,
calculating patient estimates, and obtaining prior authorization
before services are rendered. This position works with physicians,
nurses, clinic managers and financial advocates to resolve issues
that arise during the prior authorizations process. This position
is not responsible for providing care to patients.
Career-development position within field. Requires moderate skill
set and developing proficiency within discipline.
Employment is contingent on the successful completion of a
background check and the adherence to departmental policies,
including UMB's Telecommuting Agreement which requires a
distraction-free and HIPAA compliant workplace, cameras on for all
virtual calls/meetings, and the ability to work during office hours
or assigned shift (M-F, approximately 8am to 5pm Mountain Time)
regardless of what time zone you live in. Additionally, new hires
are required to provide their own monitors (two) and reliable
internet service.
Compensation & Benefits
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. All team members are
eligible for the University's comprehensive benefit package that
includes 90% employer-paid medical insurance, a generous 14.2%
retirement contribution, reduced tuition, PTO and holiday pay, and
more!
Responsibilities
Essential Functions
- 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, escalate
for resolution.
Facilitates provider and insurance medical director's reviews
for medical determination if the visit should be authorized.
Maintain familiarity with contracts, payer guidelines, and
resources to determine appropriate coverage and eligibility.
Ensures accurate ICD, CPT codes and related medical records are
submitted in the authorization request.
Resolve claims denials related to the 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 team and
department.
This job description is not designed to contain or be interpreted
as a comprehensive inventory of all duties, responsibilities and
qualifications required of employees assigned to the job.
Minimum Qualifications
Required
Three years of experience in a health care financial setting, or
equivalency (one year of education can be substituted for two years
of related work experience).
Six months of experience as a Prior Authorization Rep I or
equivalent prior-authorization experience.
Preferred
Previous experience with insurance and prior authorizations.
ICD/CPT Coding Certification.
Inpatient and day surgery prior authorizations experience.
Preferences
An especially qualified candidate will also possess the
following:
- 3 years' experience in medical setting.
- 2 years' experience working prior authorizations, which
includes:
- 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.
Disclaimer
This job description has been designed to indicate the general
nature and level of work performed by employees within this
classification. It is not designed to contain or be interpreted as
a comprehensive inventory of all duties, responsibilities and
qualifications required of employees assigned to the job.
Special Instructions
While UMB is a remote department and this role will be performed
remotely, interested applicants should note the following:
- This role is expected to work during UMB office hours which are
Monday through Friday, 8am to 5pm Mountain Time.
- The University of Utah is committed to providing jobs to
individuals located in Utah, and sees remote roles like this as an
opportunity to provide amazing employment opportunities to those
living in remote areas of the state. As such, Utah-based applicants
may be prioritized in the screening process.
- At this time, the University of Utah is unable to employ
individuals living in California, Colorado, New York, Oregon, or
Washington.
Requisition Number: PRN45958B
Full Time or Part Time? Full Time
Work Schedule Summary: UMB Office Hours; M-F 8:00am to
5:00pm Mountain Time
Department: 00209 - Univ Medical Billing - Oper
Location: Other
Pay Rate Range: $25 - $28 per hour
Close Date: 10/15/2026
Open Until Filled:
To apply, visit https://apptrkr.com/9781230"">https://utah.peopleadmin.com/postings/207826
je-40992794a55147d88ed932f894cc0b6b
