Experienced Prior Authorization Specialist

Job description

Position Title:
Experienced Prior Authorization Specialist
Department:
Pre-visit Services
Job 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 Oklahoma before their first day of employment. Please do not apply if you do not currently/will not reside in Oklahoma at the time of start.
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 high volume authorizations.**
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.

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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.