Prior Authorization Specialist II
Position Title:
Prior Authorization Specialist IIDepartment:
Pre-visit ServicesJob Description:
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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 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.