Pre-Authorization Clerk - Full Time

Job Summary

The prior authorization clerk is responsible for ensuring that payers are prepared to reimburse Uintah Basin Healthcare for scheduled services in accordance with the payer-provider contract. The clerk contacts payers to request service authorization and may collect financial and/or demographic information from patients as needed. Identifies prearranged payment plans and follows instructions as outlined by the Patient Access Manager. Requests and collects self-pay balances per organizational guidelines.

Duties and Responsibilities

• Demonstrates Competency in the Following Areas:
• Verifies patient's insurance and benefits information.
• Obtains prior authorizations from third-party payers in accordance with payer requirements.
• Contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR as necessary.
• Works with other departments to gather the clinical information required by the payer to authorize services.
• Maintains accurate records of authorizations with EMR.
• Refers accounts to financial counseling as needed if authorization is not obtained.
• Works with business office staff to support appeal efforts for authorization-related denials.
• Complies with HIPAA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality.
• Maintains a professional tone at all times when communicating with patients and payer representatives.
• Performs all other duties as assigned by departmental leaders.
• Accurately and thoroughly collects, analyzes, and records demographic, insurance, financial, and clinical data in a computer system. Ensures the information source is appropriate.
• Updates and edits information in the computer system, ensuring that all fields are populated correctly and appropriately.
• Obtains information and completes Medicare Secondary Payer Questionnaire and other payer-specific documents as required.
• Posts payments within the billing system.
• Ensures that all monies collected are secured or turned over to appropriate associates.
• Refers patients to Financial Counselors for in-depth financial counseling.
• Ability to perform a variety of tasks, often changing assignments on short notice.
• Must be adept at multi-tasking.
• Readily identifies work that needs to be performed and completes it without needing to be told.

Professional Requirements

• Ensures that appearance and personal conduct are professional at all times.
• Excellent attendance record.
• Wears appropriate clothing for job functions. Wears ID badge.
• Works at maintaining a good rapport and a cooperative working relationship with physicians, administration, and staff.
• Represents the organization in a positive and professional manner in the community.
• Maintains patient confidentiality at all times.
• Complies with all organizational policies regarding ethical business practices.
• Exceptional organization and time management skills.