Prior Authorization Specialist II

Our take on this role

About this role

Manage complex authorization requests across multiple payers and specialties, interpret payer policies, and resolve denials. Remote eligibility requires living and working full-time in Oklahoma before starting, with on-site work as needed, at least monthly.

What could you bring from clinical work?

• Nurses: Your experience interpreting clinical records and care needs may help when interpreting payer medical policies and utilization management criteria.
• OTs and SLPs: Documenting impairments and justifying skilled services could help you identify the medical necessity documentation to obtain from clinical teams.
• PTs: If you've documented functional deficits and medical necessity, that experience could help you identify missing justification when resolving authorization denials.
• Social workers: Experience addressing coverage barriers and coordinating service access may help you work through authorization denials and incomplete determinations.

Full job description from OU Health

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.

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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.