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UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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Authorization Specialist

  • Job ID: 426578961
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: Monday - Friday, 8:00 - 4:30
  • Shift: Day Job
  • Facility: UPMC Community Medicine Incorporated
  • Department: 57022 ZCPSH Horizon Ortho (Parkside)
  • Location: 449 North Hermitage Road, Hermitage PA 16148
  • Union Position: No
  • Salary Range: $14.88 to $22.66 / hour

Description

UPMC Horizon Orthopedics is hiring a full-time Authorization Specialist to join their team in Hermitage, PA! In this position, you will work Monday-Friday from 8:00am-4:30pm communicating with patients and insurance companies in order to process orders for MRIs and knee injections. No evenings, weekends, or holidays required! 

Responsibilities:

 

  • Prior authorization responsibilities1. Reviews and interprets medical record documentation for patient history, diagnosis, and previous treatment plans to pre-authorize insurance plan determined procedures to avoid financial penalties to patient, provider and facility. 2. Utilizes payor-specific approved criteria or state laws and regulations to determine medical necessity or the clinical appropriateness for inpatient admissions, outpatient facility, office services, durable medical equipment, and drugs in terms of type, frequency, extent, site and duration, and considered effective for the patient's illness, injury, or disease. 3. Ensures accurate coding of the diagnosis, procedure, and services being rendered using ICD-9-CM, CPT, and HCPCS Level II. 4. Provides referral/pre-notification/authorization services timely to avoid unnecessary delays in treatment and reduce excessive nonclinical administrative time required of providers. 5. Submits pertinent demographic and supporting clinical data to payor to request approval for services being rendered.
  • General responsibilities:1. Maintains compliance with departmental quality standards and productivity measures. 2. Works collaboratively with internal and external contacts specifically, Physician Services and Hospital Division, across UPMC as well as payors to enhance customer satisfaction and process compliance, ensuring the seamless coordination of work and to avoid a negative financial impact.3. Utilizes 18+ UPMC system and insurance payor or contracted provider web sites to perform prior authorization, edit, and denial services.4. Utilize authorization resources along with any other applicable reference material to obtain accurate prior authorization.
  • Retrospective authorization responsibilities1. Resolves basic authorization edits to ensure timely claim filing and elimination of payor rejections and or denials.
  • Access to areas where medications, syringes or sharps may be stored is necessary and permitted in order to perform routine tasks as delineated in the employee's job description

 

Qualifications

  • High School diploma or equivalent with 2 years working experience in a medical environment (such as a hospital, doctor's office, or ambulatory clinic) OR
  • Associate's degree and 1 year of experience in a medical environment required. (Bachelor's degree (B.A) preferred) Completion of a medical terminology course (or equivalent) required
  • Knowledge and interpretation of medical terminology, ICD-9, and CPT codes
  • Must be proficient in Microsoft Office applications Excellent communication and interpersonal skills
  • Ability to analyze data and use independent judgment
  • Skills Preferred: Understanding of authorization processes, insurance guidelines, third party payors, and reimbursement practicesExperience utilizing a web-based computerized system.


Licensure, Certifications, and Clearances:

  • Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran

UPMC has a Center for Engagement and Inclusion that is charged with executing leading-edge and next-generation diversity strategies to advance the organization’s diversity management capability and its national presence as a diversity leader. This includes having Employee Resource Groups, such as PRIDE Health or UPMC ENABLED (Empowering Abilities and Leveraging Differences) Network, which support the implementation of our diversity strategy.

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   Current UPMC employees must apply in HR Direct

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