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.