Trinity Employment Specialists
Prior Authorization Lead
Trinity Employment Specialists, Oklahoma City, Oklahoma, United States, 73101
Prior Authorization Lead
Summary Schedule:
MondayFriday, 8am5pm 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. #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. Please visit the Career Center on our website for some helpful resources to help in your job search, to build a resume, for interview tips and many job opportunities!
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.
Summary Schedule:
MondayFriday, 8am5pm 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. #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. Please visit the Career Center on our website for some helpful resources to help in your job search, to build a resume, for interview tips and many job opportunities!
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.