Prior Authorization Specialist II

oumedicine; Central Park (WA); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

PTO

401(k)

Medical insurance

Dental plans

Job summary

OU Health is seeking a Prior Authorization Specialist II to manage complex authorizations across multiple payers and specialties from the Pre-visit Services department. Under general supervision, you will coordinate with clinical teams to obtain medical necessity documentation and ensure timely determinations.

The role requires at least 3 years of prior authorization experience, a High School Diploma or GED, and CHAA or PACS certification after 1 year.

Qualifications

• Applied knowledge of payer medical policies.
• Experience with utilization management criteria.
• Ability to analyze denial trends and take corrective action.

Responsibilities

• 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

Skills

Payer policies interpretation

Authorization management

Denial analysis

Communication skills

Education

High School Diploma or GED

Job description

Position Title

Prior Authorization Specialist II

Department

Pre-visit Services

Job Description

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

Essential Job Duties

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.

General Job Duties

• Performs other duties as assigned

Minimum Requirements

• 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.

Knowledge, Skills & Abilities

• 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 click HERE 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.