Requisition Number: 12786
Reg/Temp: Regular
Employment Type: Full-Time
Shift: Day
Work Schedule: ..
Location Name: Business Services Building
City: SALT LAKE CITY
State: UT
Department: UUH CST 10R PAT ACCESS NOVA
EEO Statement
The University of Utah Health Care is an Affirmative Action/Equal Opportunity employer. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities. The University of Utah Health Care is committed to diversity in its workforce. Women and minorities are encouraged to apply.
Overview:
As a patient-focused organization, the University of Utah Health Care exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health Care seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA
**This description is only for the Outpatient Revenue Operations Department**
This position is responsible for a variety of functions related to insurance coverage. Collection, verification and notification of eligibility, benefits andprior authorizations and providing notification to ensure reimbursement for medical services rendered. This position routinely works with physicians, case managers, case workers, nurses, financial advocates and patients to resolve issues that arise during the prior authorizations process.
This position is not responsible for providing care to patients.
Responsibilities:
- Verifies and accurately documents insurance benefits. Creates and documents estimated patient responsibility money before service is rendered to allow for pre-service collection.
- Identifies and provides accurate CPT/ICD codes during authorization check and authorization request.
- Obtains, interprets and submits clinical documentation pertinent to the specific services requiring prior authorization to support medical necessity reviews by the payer.
- Obtains and documents prior authorization approval from insurance companies for procedures and hospital stays. Escalates to the Financial Advocate team and notifies Physician’s office when authorization is not obtained and/or benefits are inadequate.
- Follows up on denied authorization requests, escalates to financial advocates, and relays the necessary denial detail to the provider to facilitate the appeal and/or peer to peer reviews.
- Communicates professionally and timely to the physician/clinical staff regarding authorization status or delays.
- Maintains all authorization/notification related faxes and other documentation in order to support the appeals process if a claims denial is received.
- Generates census reports to submit admission notification to payers to meet inpatient authorization requirements and ensure claim reimbursement.
- Facilitates inpatient UR process by ensuring UR nurses are notified for timely clinical review during inpatient stay.
- May work to resolve claims denials related to the prior authorization process and may include account review, claim review, appeal preparation and submission.
Knowledge / Skills / Abilities:
- Basic knowledge of accounting, word processing and spreadsheets.
- Demonstrated critical thinking and ability to analyze information and problem solve.
- Demonstrated ability to provide clear and 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 web sites.
Qualifications:
- Two years experience in a health care financial setting or equivalency.
Qualifications (Preferred):
Preferred
- Previous experience with medical insurance and prior-authorizations.
- ICD/CPT Coding experience.
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.
Reg/Temp: Regular
Employment Type: Full-Time
Shift: Day
Work Schedule: ..
Location Name: Business Services Building
City: SALT LAKE CITY
State: UT
Department: UUH CST 10R PAT ACCESS NOVA
EEO Statement
The University of Utah Health Care is an Affirmative Action/Equal Opportunity employer. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities. The University of Utah Health Care is committed to diversity in its workforce. Women and minorities are encouraged to apply.
Overview:
As a patient-focused organization, the University of Utah Health Care exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health Care seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA
**This description is only for the Outpatient Revenue Operations Department**
This position is responsible for a variety of functions related to insurance coverage. Collection, verification and notification of eligibility, benefits andprior authorizations and providing notification to ensure reimbursement for medical services rendered. This position routinely works with physicians, case managers, case workers, nurses, financial advocates and patients to resolve issues that arise during the prior authorizations process.
This position is not responsible for providing care to patients.
Responsibilities:
- Verifies and accurately documents insurance benefits. Creates and documents estimated patient responsibility money before service is rendered to allow for pre-service collection.
- Identifies and provides accurate CPT/ICD codes during authorization check and authorization request.
- Obtains, interprets and submits clinical documentation pertinent to the specific services requiring prior authorization to support medical necessity reviews by the payer.
- Obtains and documents prior authorization approval from insurance companies for procedures and hospital stays. Escalates to the Financial Advocate team and notifies Physician’s office when authorization is not obtained and/or benefits are inadequate.
- Follows up on denied authorization requests, escalates to financial advocates, and relays the necessary denial detail to the provider to facilitate the appeal and/or peer to peer reviews.
- Communicates professionally and timely to the physician/clinical staff regarding authorization status or delays.
- Maintains all authorization/notification related faxes and other documentation in order to support the appeals process if a claims denial is received.
- Generates census reports to submit admission notification to payers to meet inpatient authorization requirements and ensure claim reimbursement.
- Facilitates inpatient UR process by ensuring UR nurses are notified for timely clinical review during inpatient stay.
- May work to resolve claims denials related to the prior authorization process and may include account review, claim review, appeal preparation and submission.
Knowledge / Skills / Abilities:
- Basic knowledge of accounting, word processing and spreadsheets.
- Demonstrated critical thinking and ability to analyze information and problem solve.
- Demonstrated ability to provide clear and 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 web sites.
Qualifications:
- Two years experience in a health care financial setting or equivalency.
Qualifications (Preferred):
Preferred
- Previous experience with medical insurance and prior-authorizations.
- ICD/CPT Coding experience.
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.
