Prior Authorization Lead

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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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.
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* 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.