OKLAHOMA CITY, OK
Prior Authorization Lead – Summary
Schedule: Monday–Friday, 8am–5pm
Location: Oklahoma City, OK
Pay: $18–$22/hour DOE
Key Responsibilities
Authorization Processing
Complete prior authorizations for imaging, medications, referrals, clinic visits, surgeries, and interventional procedures.
Review clinical notes, CPT/HCPCS codes, ICD-10 accuracy, and medical necessity before submission.
Confirm payer requirements (PT, conservative care, imaging timelines, evaluations, cardiac clearance, etc.).
Coordinate peer-to-peer reviews and prepare provider documentation.
Insurance & Payer Coordination
Verify benefits, coverage limits, exclusions, and cost estimates.
Submit authorizations via payer portals (Availity, UHC, BCBS, Cigna, Aetna, Medicaid, Cohere, AIM, Evicore, MedImpact).
Monitor status, resolve delays, and respond to requests for additional documentation.
Workflow Leadership
Act as the escalation point for complex or stalled authorizations.
Train new staff on authorization processes, payer rules, and ECW workflows.
Support cross-coverage for multiple clinic locations.
Audit accuracy, timeliness, and documentation; update SOPs and workflow guides as needed.
Collaboration & Scheduling Support
Coordinate with scheduling teams to ensure all patients have valid authorizations before booking.
Track procedures and pre-work to prevent cancellations.
Communicate updates to providers and clinical teams to maintain smooth patient flow.
Partner with operations to improve workflows and turnaround times.
Documentation & Reporting
Maintain detailed authorization logs in ECW, including attachments, approval numbers, and expiration dates.
Produce daily/weekly reports on pending, approved, denied, or expiring authorizations.
Identify denial trends and escalate issues to leadership.
Monitor turnaround times for compliance.
Compliance & Quality Control
Stay current on payer policies, OK Medicaid guidelines, Medicare rules, and commercial insurance requirements.
Ensure all authorizations meet compliance standards to prevent claim denials.
Protect patient information per HIPAA regulations.
Qualifications
5+ years of prior authorization experience in a medical or specialty practice.
Strong knowledge of commercial, Medicare, and Medicaid processes and appeals.
Experience with eClinicalWorks (ECW) preferred.
Ability to interpret medical documentation and CPT/ICD-10 codes.
Excellent communication and collaboration skills.
Highly organized, detail-oriented, and able to manage multiple deadlines.
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Qualifications
- At least five years of prior authorization experience in a medical or specialty practice