Insurance Utilization Reviewer Jobs in Utah (NOW HIRING)

Position Summary: The Registration Representative performs accurate, timely, compliant patient access functions across all registration access points, including front office, emergency department, clinic, outpatient, ancillary, surgical, imaging, laboratory, and hospital service areas. The position verifies patient identity, prevents duplicate medical records, collects and updates demographic and guarantor information, verifies insurance eligibility and benefits, completes Medicare Secondary Payer requirements, confirms required orders and authorizations, obtains required consents and notices, supports point-of-service collections when appropriate, and prepares encounters for service, documentation, billing, and claim submission.

The Registration Representative is responsible for front-end patient access work performed for hospital, emergency department, clinic, outpatient, ancillary, surgical, imaging, laboratory, observation, inpatient, self-pay, Medicare, Medicaid, commercial, managed care, workers compensation, and other payer encounters. The position directly affects patient identification, clinical record accuracy, authorization completion, payer compliance, clean claim performance, denial prevention, patient financial communication, and audit readiness.

This position reports to the Business Office Manager or other assigned revenue cycle leader and is accountable for completing assigned registration duties accurately, following approved procedures, meeting productivity and accuracy standards, escalating unresolved issues, and maintaining documentation that supports billing, compliance, and audit review.   

Kane County Hospital is a Critical Access Hospital that operates hospital, emergency department, outpatient, ancillary, surgical, ambulance, and clinic services. Registration Representatives work with patients, families, providers, nursing, laboratory, imaging, surgery, Health Information Management, coding, billing, utilization review, payers, and leadership. The position requires accuracy, confidentiality, calm communication, payer knowledge, system discipline, and strict compliance with emergency care requirements.

The Registration Representative must perform all duties in full compliance with applicable federal and Utah laws, regulations, payer contracts, Medicare and Medicaid rules, commercial insurance requirements, privacy and security requirements, hospital policies, compliance plan requirements, patient rights requirements, financial assistance requirements, emergency department requirements, and audit standards. The position must not knowingly create duplicate records, enter unsupported information, bypass required fields, ignore payer requirements, delay emergency screening or stabilizing treatment for registration or payment activity, or permit encounters to proceed without required escalation when material information is missing.   

 1. Register patients accurately across front office, emergency department, clinic, outpatient, ancillary, imaging, laboratory, surgical, observation, inpatient, and other assigned access points.

2. Verify patient identity before creating or updating an encounter; confirm legal name, date of birth, billing and clinical sex or gender requirements, and the correct medical record number.

3. Search the master patient index before registration; prevent duplicate medical records; correct approved demographic errors; and escalate identity conflicts immediately.

4. Collect, verify, and update all required demographic and financial fields, including address, phone numbers, email, emergency contact, guarantor, subscriber, accident, workers compensation, and employer information.

5. Obtain and scan current insurance cards; verify payer order, subscriber information, active coverage, real-time eligibility, and coordination of benefits for the date of service.

6. Complete Medicare Secondary Payer questionnaires for Medicare beneficiaries; identify any primary payer; document responses; and confirm payer sequence before service when operationally possible.

7. Confirm required orders, diagnosis information, medical necessity screening, ordering provider, attending or admitting provider, service location, and encounter type.

8. Determine authorization, referral, notification, or payer approval requirements; verify approval numbers and effective dates; document authorization details; and escalate missing approvals before service according to procedure.

9. Obtain required consents, HIPAA acknowledgments, assignment of benefits, financial responsibility forms, Medicare notices, observation notices, electronic signatures, and other legal forms by service type and payer requirement.

10. Follow emergency department registration requirements; collect only minimal identifying information before medical screening when appropriate; do not delay screening, stabilization, or transfer; and do not discuss payment before stabilization.

11. Estimate patient responsibility when tools and information are available; explain deductibles, copays, coinsurance, self-pay expectations, payment options, and financial assistance resources; and collect point-of-service payments when appropriate and allowed.

12. Complete final registration accuracy review before encounter completion, including required fields, payer selection, scanned documents, signed forms, authorization status, order validation, and billing readiness.

13. Maintain assigned work queues, registration edits, missing information lists, authorization follow-up items, eligibility failures, returned encounters, and correction requests within required timelines.

14. Perform other related duties as assigned by the Business Office Manager, Chief Financial Officer, or designated revenue cycle leader.

15. Complete a daily second-level verification of all registrations completed since the prior review; this review must be performed by someone other than the registering agent and must confirm that demographic information, insurance coverage, authorization status, payer sequence, guarantor and subscriber information, scanned documents, required forms, and all other face-sheet information are complete, accurate, current, and ready for billing and audit review.

  Knowledge, Skills, and Abilities

1.       Working knowledge of patient access operations, including scheduling support, registration, admissions, emergency department intake, clinic intake, insurance verification, authorizations, referrals, financial counseling support, and point-of-service collections.

2.       Ability to verify identity, prevent duplicate records, enter accurate demographic data, confirm insurance coverage, identify payer order, document authorizations, and recognize missing or conflicting information.

3.       Knowledge of Medicare, Medicaid, commercial payer, managed care, workers compensation, self-pay, Medicare Secondary Payer, coordination of benefits, patient responsibility, and financial assistance workflows.

4.       Ability to follow emergency department requirements, including EMTALA-related registration limits, medical screening priorities, stabilization requirements, and restrictions on payment discussions before stabilization.

5.       Ability to work accurately in Oracle (Cerner), SSI, eligibility tools, payer portals, scanning systems, payment collection tools, and other assigned registration or revenue cycle systems.

6.       Strong communication skills with patients, families, clinical staff, providers, payers, auditors, and leadership, including the ability to explain required forms and financial expectations respectfully and clearly.

7.       Commitment to confidentiality, patient rights, accuracy, service recovery, professionalism, compliance, revenue integrity, and audit-ready documentation.

8.       Ability to work independently, prioritize patients safely, manage interruptions, meet deadlines, resolve routine registration problems, and escalate issues that affect care, compliance, authorization, billing, or patient experience.