Prior Authorization Specialist – Vital Care of Oklahoma City
The Prior Authorization Specialist is responsible for obtaining insurance authorizations for infusion therapies and specialty medications to ensure timely access to patient care. This position works closely with physicians, referral sources, insurance providers, and internal clinical and reimbursement teams to gather required documentation, submit authorization requests, monitor approval status, and resolve authorization-related issues. The Prior Authorization Specialist ensures all requests are processed accurately, efficiently, and in compliance with payer guidelines while providing exceptional service to patients and healthcare providers.
Qualifications
- High school diploma or GED required; Associate’s degree in healthcare administration, business, or a related field preferred.
- Minimum of 2 years of experience in prior authorizations, medical insurance, specialty pharmacy, infusion therapy, or a related healthcare setting preferred.
- Strong knowledge of commercial insurance, Medicare, Medicaid, and payer authorization requirements.
- Experience submitting and tracking prior authorization requests through payer portals and electronic systems.
- Working knowledge of medical terminology, ICD-10, CPT, and HCPCS coding preferred.
- Familiarity with electronic health records (EHR/EMR), pharmacy management systems, and Microsoft Office applications.
- Excellent organizational skills with the ability to prioritize multiple cases and meet deadlines.
- Strong analytical and problem-solving skills with exceptional attention to detail.
- Excellent verbal and written communication skills with the ability to effectively interact with physicians, insurance representatives, patients, and internal teams.
- Knowledge of HIPAA regulations and a commitment to maintaining patient confidentiality.
- Ability to work independently while contributing to a collaborative, fast-paced team environment.
Preferred Qualifications
- Experience in home infusion, ambulatory infusion, specialty pharmacy, or reimbursement services.
- Knowledge of specialty biologics and infusion medications.
- Experience with appeals, denials, and insurance authorization follow-up.
- Bilingual (English/Spanish) is a plus but not required.
Company Description:
Vital Care is an infusion pharmacy dedicated to delivering high-quality care through a personalized, high-touch approach. The organization focuses on making infusion therapy services straightforward and accessible for patients, providers, and caregivers. By coordinating closely with healthcare teams, Vital Care supports safe and effective treatment in comfortable, convenient settings. Team members are encouraged to build trusting relationships with those they serve while upholding the highest standards of clinical practice and customer service.
