Prior Authorization Specialist II

OU Medicine; Oklahoma; On-site; USD 48,000 - 56,000; Full time

Job summary

OU Health is seeking a qualified Prior Authorization Specialist II to manage complex authorizations across multiple payers and specialties. The role requires independent handling of complex requests and coordination with clinical teams to obtain necessary documentation.

The ideal candidate has 3+ years of prior authorization experience, CHAA or PACS certification within the first year, and strong communication skills to resolve denials and ensure timely determinations.

Qualifications

• Experience interpreting payer medical policies.
• Knowledge of specialty‑driven authorization requirements.
• Ability to analyze denial trends and recommend corrective actions.
• Excellent written and verbal communication skills.

Responsibilities

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

Education

High School Diploma or GED

Job description

Position Title:Prior Authorization Specialist IIDepartment:Pre-visit ServicesJob Description:New to OU Health? Ask your recruiter about our competitive wages and total rewards package.Remote Eligibility: Candidates must reside and work full-time in OK before their first day of employment.SHIFT: M-F, Days. Will need to be on-site as needed, at least monthly.**Ideal candidate will have experience in pre-visit services for multiple areas, working with authorizations.**General DescriptionUnder general supervision, the Prior Authorization Specialist II effectively manages complex authorizations across multiple payers and specialties.Essential Job DutiesResponsibilities 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 DutiesPerforms other duties as assignedMinimum RequirementsEducation: 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 & AbilitiesApplied 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.#cbCurrent 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.