Prior Authorization Lead
22 days ago
Oklahoma City
Job Description 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.)., • Verify benefits, coverage limits, exclusions, and cost estimates., • Submit authorizations via payer portals (Availity, UHC, BCBS, Cigna, Aetna, Medicaid, Cohere, AIM, Evicore, MedImpact)., • 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., • 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., • 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., • 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. #HP TRINITY EMPLOYMENT SPECIALISTS IS AN EQUAL OPPORTUNITY EMPLOYER See the great things people are saying by checking out our Google reviews, along with our Facebook, LinkedIn, Instagram, X/Twitter. 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At least five years of prior authorization experience in a medical or specialty practice • Determine eligibility of persons applying to receive assistance from government programs and agency resources, such as welfare, unemployment benefits, social security, and public housing., • Interpret and explain information such as eligibility requirements, application details, payment methods, and applicants' legal rights., • Interview benefits recipients at specified intervals to certify their eligibility for continuing benefits., • Keep records of assigned cases, and prepare required reports., • Compile, record, and evaluate personal and financial data to verify completeness and accuracy, and to determine eligibility status., • Answer applicants' questions about benefits and claim procedures., • Interview and investigate applicants for public assistance to gather information pertinent to their applications., • Initiate procedures to grant, modify, deny, or terminate assistance, or refer applicants to other agencies for assistance., • Check with employers or other references to verify answers and obtain further information., • Compute and authorize amounts of assistance for programs, such as grants, monetary payments, and food stamps., • Investigate claimants for the possibility of fraud or abuse., • Refer applicants to job openings or to interviews with other staff, in accordance with administrative guidelines or office procedures., • Schedule benefits claimants for adjudication interviews to address questions of eligibility., • Monitor the payments of benefits throughout the duration of a claim., • Prepare applications and forms for applicants for such purposes as school enrollment, employment, and medical services., • Provide applicants with assistance in completing application forms, such as those for job referrals or unemployment compensation claims., • Conduct annual, interim, and special housing reviews and home visits to ensure conformance to regulations., • Provide social workers with pertinent information gathered during applicant interviews., • Maintain files and control records to show correspondence activities., • Compose letters in reply to correspondence concerning such items as requests for merchandise, damage claims, credit information requests, delinquent accounts, incorrect billing, or unsatisfactory service., • Read incoming correspondence to ascertain nature of writers' concerns and to determine disposition of correspondence., • Prepare documents and correspondence, such as damage claims, credit and billing inquiries, invoices, and service complaints., • Gather records pertinent to specific problems, review them for completeness and accuracy, and attach records to correspondence as necessary., • Compile data from records to prepare periodic reports.