Prior Authorization Specialist

Unifi Healthcare•Provo, UT

101d

About The Position

The Prior Authorization Specialist is responsible for completing prior authorizations for medical equipment, advocating for patients seeking approval for Durable Medical Equipment through the Department of Labor. The role requires strong writing skills, clinical experience, organization, dedication, persistence, independent problem-solving, and the ability to address and resolve confrontation. The specialist oversees daily authorization team functions and serves as an authorization-area float. The position works closely with Department of Labor medical benefit examiners, case managers, patients, and internal departments. It includes writing letters of medical necessity, working with insurance payers to secure prior authorization approvals, verifying eligibility and benefits, and maintaining accurate documentation. The specialist also follows organizational policies, external agency requirements, and applicable coding, billing, HIPAA, and industry guidelines.

Requirements

High school diploma or equivalent.
Demonstrated successful work history writing and handling prior authorizations, appeals, and denials.
Strong writing, communication, organizational, interpersonal, and customer service skills.
High degree of computer literacy in a PC environment.
Strong attention to detail and accuracy in data entry, documentation, and claims processing.
Ability to handle confidential and sensitive information with discretion.
Strong problem-solving and analytical skills.
Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
Knowledge of medical terminology, anatomy, diagnosis codes, and/or procedures.
Ability to work independently in a remote setting while collaborating with a team and managing project deadlines.
Ability to meet U.S. employment and eligibility requirements.

Nice To Haves

Medical Assistant degree, LPN, RN, or equivalent.
Two years of medical experience.
Previous experience successfully completing federal payer authorizations.
Six months of experience with prior authorizations, preferably federal and commercial.
Brightree experience.
Department of Labor experience.

Responsibilities

Write an average of 20 letters of medical necessity per day.
Work with insurance payers daily to obtain prior authorization approvals.
Understand and accurately apply prior authorization requirements.
Verify patient eligibility and benefits.
Advocate for patients and provide excellent customer service.
Oversee daily functions of the authorization team and act as an authorization-area float.
Work with Department of Labor medical benefit examiners, case managers, patients, internal departments, and remote teams in multiple states.
Maintain accurate, up-to-date documentation of authorizations, claims, appeals, and internal and external communications.
Comply with departmental policies and procedures, external agency requirements, coding and billing regulations, HIPAA, and other industry guidelines.
Follow service standards and success factors and demonstrate professional work behavior.
Perform other related duties as assigned or requested to maintain a high level of service.