Authorization Specialist, Prior Auth & Epic EMR
Overview
You will own the prior authorization lifecycle for surgical procedures, DME, and specialty medications across multiple outpatient clinics at UNLV Health. You will act as the critical link between practitioners, payers, and patients, deploying daily to diverse specialties. Working within Epic EMR, you will document every touchpoint and submission to ensure full transparency and compliance. This float pool role demands rapid adaptability and sharp payer navigation to prevent care delays and financial risk. You will accelerate approvals using Availity, Optum/Change Healthcare, UnitedHealthcare Link, and CoverMyMeds.
What You'll Do7
- 1Secure prior authorizations for complex surgical procedures, high-cost DME, and specialty/retail medications across varied clinical environments.
- 2Navigate multiple payer channels: online portals (Availity, Optum/Change Healthcare, UnitedHealthcare Link), Epic Care Link, and CoverMyMeds, with telephonic and fax escalations for expedited approvals.
- 3Record every payer conversation, submitted clinical document, and follow-up metric within the Epic EMR encounter for full transparency.
- 4Review provider documentation and diagnostic reports against payer criteria to submit a clean, justified authorization packet on first attempt.
- 5Manage denials: identify peer-to-peer review needs, coordinate with practitioners to supply missing data, or schedule payer reviews to overturn denials.
- 6Transition between clinics weekly, adapting to different procedural workflows and medication profiles across medical specialties.
- 7Proactively contact patients when complex drug formulas, DME models, or surgical dates face insurance delays; gather patient-reported data to push approvals forward.
Requirements8
- 12+ years of direct experience managing prior authorizations in an outpatient ambulatory care setting or medical billing environment.
- 21+ year of hands-on experience with Epic EMR, specifically Epic Cadence/Prelude or referral standard workflows.
- 3Bilingual English/Spanish required.
- 4Knowledge of health plans, eligibility, and guidelines.
- 5Demonstrated ability to read, write, and speak English.
- 6Demonstrated ability to use a computer, with minimum typing speed of 35 wpm.
- 7High School Diploma or equivalency; Associate degree or healthcare administration coursework preferred.
- 8Experience floating or working across multiple specialties is highly desirable.
Salary Insight
$40 - $46k per year
Location
Required Skills
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