Prior Authorization Specialist II

Position Title

Prior Authorization Specialist II

Pre-visit Services

General Description Under general supervision, the Prior Authorization Specialist II effectively manages complex authorizations across multiple payers and specialties.

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities, with or without an accommodation, may result in disqualification from the position.

• Independently manage complex and specialty-specific authorization requests.
• Interpret payer medical policies and utilization management criteria.
• Resolve authorization denials and incomplete determinations.
• Coordinate with clinical teams to obtain medical necessity documentation.

• Performs other duties as assigned

• Education:
  
  High School Diploma or GED required.
• Experience:
  
  At least 3 years of prior authorization experience required.
• Certification/License/Registration: CHAA or PACS required after 1 year.

• Applied expertise in payer medical policy interpretation.
• Strong knowledge of specialty-driven authorization requirements.
• Ability to analyze denial trends and recommend corrective actions.
• Excellent written and verbal communication skills.

Current OU Health Employees - Please  to login.

OU Health is an equal opportunity employer.

• We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more.

We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.