Prior Authorization Specialist II

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 specialtyspecific authorization requests.
• Interpret payer medical policies andutilizationmanagementcriteria.
• Resolveauthorizationdenials 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

• Appliedexpertisein payer medical policy interpretation.
• Strong knowledge of specialtydriven authorization requirements.
• Ability to analyze denial trends and recommend corrective actions.
• Excellent written and verbal communication skills.