Ambulatory Prior Authorization Specialist

UNLV Medicine; Las Vegas (NV); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Weekday schedule 8am–5pm

Paid holidays (12 full, 2 half days)

PTO 20 days/year

Medical, Dental, Vision benefits start

Job summary

UNLV Health seeks a Per Diem Float Pool Authorization Specialist to secure prior authorizations for surgical procedures, DME, and medications across ambulatory clinics. You will act as a critical link between clinicians, payers, and patients to minimize delays and ensure compliant documentation in Epic EMR.

Requirements include 2+ years in outpatient prior authorizations, bilingual English/Spanish, and strong knowledge of payer guidelines.

Qualifications

• Two years of direct experience managing prior authorizations in outpatient ambulatory care.
• Experience floating across multiple specialties is highly desirable.
• Must be bilingual English/Spanish.
• Knowledge of health plans, eligibility and guidelines.
• Experience with Epic EMR workflows.

Responsibilities

• Prior Authorization Procurement: Initiate, track, and secure prior authorizations for complex procedures, high-cost DME, and medications.
• Multi-Channel Payer Navigation: Use online portals and Epic tools to obtain expedited approvals.
• Epic EMR Documentation: Record all touchpoints and communications in Epic encounters.
• Clinical Review & Assembly: Review provider notes and diagnostics to submit a complete packet on first submission.
• Denial Management & Escalation: Identify ne eds and coordinate with providers to overturn denials quickly.
• Float Pool Adaptability: Move between ambulatory clinics adapting to different workflows.
• Care Interruption Mitigation: Notify patients of delays and provide timeline updates.

Skills

Bilingual English/Spanish

Typing 35 wpm

Communication skills

Education

High School Diploma or equivalent

Associate degree preferred

Tools

Epic EMR (Cadence/Prelude)

Availity / Optum / Change Healthcare portals

CoverMyMeds

Epic Care Link

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Las Vegas, NV, US

21 days ago Requisition ID: 2188

Salary Range: $19.60 To $22.13 Annually

The Per Diem Float Pool Authorization Specialist is a highly adaptable, detail-oriented professional responsible for securing timely prior authorizations for surgical procedures, durable medical equipment (DME), and medications across various outpatient ambulatory clinics within UNLV Health. Acting as a critical link between clinic practitioners, insurance payers, and patients, this role mitigates financial risk, prevents delays in patient care, and ensures administrative continuity. By deploying to diverse clinical specialties on an as-needed basis, the specialist accelerates the approval process utilizing advanced healthcare portals and ensures strict, standardized documentation compliance within the Epic EMR system.

Candidates must be legally authorized to work in the United States. Please Note: UNLV Health does not provide employment sponsorships or sponsorship transfers for any positions.

ADVANTAGES OF WORKING FOR UNLV HEALTH

• Working Monday through Friday, 8AM to 5PM (Actual hours may vary depending on business need)
• 12 Full-Day and 2 Half-Day Paid Holidays per year, starting with your first day of employment
• 20 PTO days per year (Depending on Position)
• Medical, Dental, and Vision benefits that start the first of the month following your start date

MAJOR RESPONSIBILITIES

• Prior Authorization Procurement: Initiate, track, and secure prior authorizations for complex surgical procedures, high-cost DME, and specialty/retail medications across varied clinical environments.
• Multi-Channel Payer Navigation: Utilize online insurance portals (e.g., Availity, Optum/Change Healthcare, UnitedHealthcare Link), Epic Care Link and dedicated pharmacy tools (CoverMyMeds), and direct telephonic/fax escalations to obtain expedited approvals.
• Epic EMR Documentation Excellence: Record every touchpoint, payer conversation, submitted clinical document, and follow-up metric within the dedicated Epic EMR encounter to ensure complete transparency across UNLV Health.
• Clinical Review & Assembly: Review provider documentation, clinical notes, and diagnostic reports against specific payer criteria to submit a clean, highly justified authorization packet on the first attempt.
• Denial Management & Escalation: Identify peer-to-peer review requirements or immediate administrative denials. Coordinate rapidly with ordering practitioners to supply missing clinical data or schedule payer-to-provider reviews to overturn denials quickly.
• Float Pool Adaptability: Seamlessly transition between different ambulatory clinics daily or weekly, rapidly adapting to the distinct procedural workflows and medication profiles of diverse medical specialties.
• Care Interruption Mitigation: Proactively contact patients when complex drug formulas, specific DME models, or surgical dates face extensive insurance processing delays. Provide clear timeline updates and gather any required patient-reported historical data to push the approval forward.

EDUCATIONAL REQUIREMENTS

• High School Diploma or equivalency. Associate degree or healthcare administration coursework preferred.

QUALIFICATIONS

• Two yearso f direct experience managing prior authorizations in an outpatient ambulatory care setting or medical billing environment.
• Experience floating or working across multiple specialties is highly desirable.
• Must be Bilingual English/Spanish
• Knowledge of health plans, eligibility and guidelines
• Demonstrated ability to read, write and speak English
• Demonstrated ability to use a computer
• Minimum typing speed of 35 wpm
• Minimum 1 year of hands-on experience utilizing Epic EMR (specifically Epic Cadence/Prelude or Referral standard workflows).

PHYSICAL REQUIREMENTS

• May include standing, sitting, and/or walking for extended periods
• May include performing repetitive tasks
• May include lifting up to 25 pounds

Ability to travel to various UNLV Health ambulatory clinic locations as assigned.

UNLV Health will provide equal opportunity employment to all employees and applicants for employment. No person shall be discriminated against in employment because of race, color, gender, age, national origin, ancestry, religion, physical or intellectual disability, marital status, parental status, sexual orientation, or any other category protected by law.