Express Scripts Prior Authorization Jobs in Utah

Overview

This is an on-sight open position available supporting Huntsman Mental Health (HMHI) Crisis Care Center services. Flex hours between 7:30-8:30 as start time.

This role is responsible for supporting patients with insurance enrollment, financial counseling, and appointment coordination. Key responsibilities include assisting with Utah Medicaid enrollment, coverage discovery, and financial screening, as well as helping patients access additional resources such as grants, MSS, and the HMHI Hope Fund. The position coordinates clinic services for scheduled appointments, manages inbound and outbound calls regarding insurance verification, self-pay policies, and deposit requirements, and creates cost estimates for upcoming appointments and patient inquiries.

Additional duties include reviewing insurance benefits, discussing authorization denials and out-of-network concerns, providing inpatient admission benefit reviews and self-pay service estimates, and collecting pre-payments. The role also involves discussing financial assistance options, referring patients to the SBO when appropriate, and collaborating with the HMHI care team and external partners, including Take Care Utah, to ensure patients receive the support and resources needed to access care.

This position is responsible for informing and assisting patients with their financial obligations for health care services through education, coverage enrollment assistance, financial hardship applications, or other programs. This position is not responsible for providing care to patients.

As a patient-focused organization, University of Utah Health 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 seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.

Responsibilities

Essential Functions

• Conducts interviews and screenings for unfunded patients to determine all available funding sources (s) including commercial insurance, government programs (Medicare, Medicaid), Crime Victims, Affordable Care Act plans, Third Party Liability, or other programs/sources.

• Works with government agencies, third party payers, and other key parties to process applications, paperwork or other requirements until completion and/or resolution.

• Assists uninsured patients with financial hardship applications. May grant full or partial charity, prompt pay discounts, or payment arrangements, as necessary.

• Creates service price estimates based on insurance benefits and/or self-pay status for upcoming services on prospective patients.

• Collects estimated patient responsibility throughout the revenue cycle both in person and over the phone.

• May coordinate and obtain "Certificate of Medical Necessity" or other approval for scheduled services when patient is unable to make a substantial or minimum payment towards services.

• Coordinates communication with patients, families, providers, or other key parties when authorization or benefits are not secured.

• May obtain prior authorizations from insurance carrier, including CPT code determination and submission of required documentation.

• Displays and understands the difference between individual and collective accountability; promotes cooperation and commitment to team goals.

• May perform other duties as assigned.

Knowledge / Skills / Abilities

• The ability to express information in a clear and understandable manner.

• Demonstrated exceptional time management skills.

• The ability to service and resolve customer requests with the customer in mind, first and foremost.

• Ability to take ownership for the quality and timeliness of work and can achieve results with little oversight.

• Ability to solicit and act on constructive feedback, challenge oneself with tough assignments, and demonstrate resilience and courage in the face of setbacks and oppositions.

Qualifications

Required

• Three years of experience with medical accounts receivable, insurance claims, or equivalency.

• High School Diploma, or equivalency.

Qualifications (Preferred)

Preferred

• Bilingual language skills may be preferred.

• Experience with the Medicaid enrollment process.

• Coding certifications such as CCS, CPC-H, or CPC-P.

• Knowledge of CPT , ICD9/10 and DRG codes.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull, or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements

Listening, Sitting, Speaking

Multi-lingual Candidates Welcomed

To inquire about this posting, email: careers@hsc.utah.edu

EEO Statement

University of Utah Health Hospitals and Clinics, a part of The University of Utah, values candidates who have experience working in settings with students and patients from all backgrounds and possess a strong commitment to improving access to higher education and quality healthcare for historically underrepresented students and patient populations.

All qualified individuals are encouraged to apply. 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.

University of Utah Health Hospitals and Clinics, a part of The University of Utah, is an Affirmative Action/Equal Opportunity employer and 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, please contact the University of Utah Health Hospitals and Clinics Human Resources office at 801-581-6500. 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 (OEO). More information, including the Director/Title IX Coordinator's office address, electronic mail address, and telephone number can be located at:www.utah.edu/nondiscrimination/

Online reports may be submitted atoeo.utah.edu/

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 Hospitals and Clinics Human Resources at (801) 581-6500 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 Hospitals and Clinics Human Resources at (801) 581-6500 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.

Requisition Number 85347
Reg/Temp Regular
Employment Type Full-Time
Shift Day
Work Schedule 8-4:30pm
Clinical/Non-Clinical Status Non-Clinical
Location Name Huntsman Mental Health Institute (HMHI)
Workplace Set Up On-site
City SALT LAKE CITY
State UT
Department COR ISC 10D FINANCIAL ADVOCATE
Category Customer Service
Workplace Set Up On-site