Prior Authorization Representative II

Open Date

Requisition Number

Job Title

Working Title

Career Progression Track

FLSA Code

Patient Sensitive Job Code?

Standard Hours per Week

Full Time or Part Time?

Shift

Work Schedule Summary

VP Area

Department

Location

City

Type of Recruitment

Pay Rate Range

Close Date

Priority Review Date (Note - Posting may close at any time)

Job Summary

Responsibilities

1. 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.    

2. 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.   
3. Serve as a liaison between the payer and clinic schedulers/medical support staff.   
4. Complete other duties as assigned to support team and department. 

Minimum Qualifications

Preferences

• 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 

Type

Special Instructions Summary

• 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. 

Additional Information

The University is a participating employer with Utah Retirement Systems (“URS”). Eligible new hires with prior URS service, may elect to enroll in URS if they make the election before they become eligible for retirement (usually the first day of work). Contact Human Resources at (801) 581-7447 for information. Individuals who previously retired and are receiving monthly retirement benefits from URS are subject to URS’ post-retirement rules and restrictions. Please contact Utah Retirement Systems at (801) 366-7770 or (800) 695-4877 or University Human Resource Management at (801) 581-7447 if you have questions regarding the post-retirement rules.

This position may require the successful completion of a criminal background check and/or drug screen.

The University of Utah values candidates who have experience working in settings with students and possess a strong commitment to improving access to higher education.

Veterans’ preference is extended to qualified applicants, upon request and consistent with University policy and Utah state law. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities.

Consistent with state and federal law, the University of Utah does not discriminate based upon race, ethnicity, color, religion, national origin, age, disability, sex, sexual orientation, gender, gender identity, gender expression, pregnancy, pregnancy-related conditions, genetic information, or protected veteran’s status. The University does not discriminate on the basis of sex in the education program or activity that it operates, as required by Title IX and 34 CFR part 106. The requirement not to discriminate in education programs or activities extends to admission and employment. Inquiries about the application of Title IX and its regulations may be referred to the Title IX Coordinator, to the Department of Education, Office for Civil Rights, or both.

To request a reasonable accommodation for a disability or if you or someone you know has experienced discrimination or sexual misconduct including sexual harassment, you may contact the Director/Title IX Coordinator in the Office of Equal Opportunity and Title IX (OEO). More information, including the Director/Title IX Coordinator’s office address, electronic mail address, and telephone number can be located at the: University of Utah Non‑Discrimination page.

Online reports may be submitted at https://oeo.utah.edu

https://publicsafety.utah.edu/safetyreport/ This report includes statistics about criminal offenses, hate crimes, arrests and referrals for disciplinary action, and Violence Against Women Act offenses. They also provide information about safety and security-related services offered by the University of Utah. A paper copy can be obtained by request at the Department of Public Safety located at 1658 East 500 South.

As per University of Utah policy 5-108: Transfer of Benefits Eligible Staff Members, a new hire to the University of Utah who is still serving a 12 month probationary period will not be hired into another University of Utah job (a transfer) until the successful completion of the probationary period.