Prior Authorization Specialist II

Position Title: Prior Authorization Specialist II 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 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. #cb 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. OU Health is the state’s only comprehensive academic health system of hospitals, clinics and centers of excellence. With 11,000 employees and more than 1,300 physicians and advanced practice providers, OU Health is home to Oklahoma’s largest doctor network with a complete range of specialty care. OU Health serves Oklahoma and the region with the state’s only freestanding children’s hospital, the only National Cancer Institute-Designated OU Health Stephenson Cancer Center, Oklahoma’s flagship hospital, which serves as the state’s only Level 1 trauma center and Edmond Medical Center in the heart of the Edmond Community. Becker’s Hospital Review named University of Oklahoma Medical Center one of the 100 Great Hospitals in America for 2020. OU Health’s oncology program at OU Health Stephenson Cancer Center was named Oklahoma’s top facility for cancer care by U.S. News & World Report in its 2020-21 rankings. OU Health also was ranked by U.S.
• News &
• World
• Report as high performing in these specialties: Colon Surgery, COPD and Congestive Heart Failure. OU Health’s mission is to lead healthcare in patient care, education and research. Experts in prevention, treatment and cures, our team works to improve lives through innovation in medical care, education and research, while investing in the people, technologies and facilities that will enable us to achieve our goals. We are seeking individuals who have a passion and talent for caring for others. By joining our team, you will provide quality health care to our community through the work you do every day. We provide clinical and non-clinical opportunities to further your career and we invite you to explore our available positions. Equal employment opportunities are provided to all employees and applicants for employment without regard to race, color, religion, gender, national origin, age, disability, sexual orientation, gender identity, genetic information or protected veteran status in accordance with applicable federal laws. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, transfer, leaves of absence, compensation, and training. Reasonable accommodations are made to the known physical and mental limitations of qualified individuals with disabilities.