Prior Authorization Specialist

About Unifi Healthcare

Unifi Healthcare is transforming healthcare delivery to be more accessible, compassionate, and centered around the patient. We aim to provide a smooth, personalized healthcare experience that supports individuals throughout their journey, enabling them to live longer and safer lives at home. Our expanding network of services and partners is focused on simplifying healthcare, assisting caregivers, and redefining home healthcare across the United States.

Role Overview

We seek a qualified Authorization Escalation Specialist with strong clinical writing skills experienced in managing prior authorizations for Medical Equipment. This role demands exceptional organization, dedication, and persistence to secure prior authorization approvals and serve as a patient advocate working within the Department of Labor framework. The specialist must have problem-solving capabilities, conflict resolution skills, and be capable of leading and supporting the authorization team's daily operations, including acting as a float for the authorization area. The position collaborates closely with DOL medical benefit examiners, case managers, patients, and various internal teams.

Key Responsibilities

• Draft an average of 20 detailed letters of medical necessity per day.
• Communicate effectively over the phone with various stakeholders.
• Coordinate frequently with insurance payers to obtain prior authorization approvals.
• Work efficiently with remote teams located across multiple states.
• Apply prior authorization requirements accurately and thoroughly.
• Verify patient eligibility and benefits to ensure compliance.
• Provide exemplary customer service and act as a patient advocate.
• Execute additional tasks as necessary to sustain high service quality.
• Display professional conduct by adhering to service standards and success criteria.
• Follow organizational policies and comply with external agency mandates.
• Maintain compliance with coding, billing rules, HIPAA, and relevant industry regulations.
• Keep meticulous documentation of authorizations, claims, appeals, and internal and external communications.

Required Skills and Knowledge

• Proven success in writing and managing prior authorizations, appeals, and denial processes.
• Effective communication and collaborative skills to enhance patient care and streamline clinic operations.
• Strong writing abilities and customer service excellence.
• High computer literacy in a PC environment.
• Organizational and interpersonal skills with strong attention to detail.
• Experience with federal payer authorization processes is preferred.
• Discretion in handling confidential and sensitive information.
• Problem-solving aptitude and analytical skills to resolve issues efficiently.
• Capacity to prioritize tasks, work independently, and meet deadlines in a dynamic environment.
• Knowledge of medical terminology, anatomy, diagnosis codes, and procedures.
• Competency to independently manage work in a remote setting while fostering team collaboration.

Education and Qualifications

• High school diploma or equivalent is mandatory.
• Preferred qualifications include Medical Assistant Degree, LPN, RN, or comparable credentials.
• Highly preferred: Minimum two years of medical experience.
• Experience using Brightree software is advantageous.
• Familiarity with Department of Labor processes.
• At least six months of experience dealing with prior authorizations from federal and commercial payers.
• Must meet U.S. employment eligibility criteria.