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Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

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: 585115660
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: Monday - Friday, 8:00 - 4:30
  • Shift: Day Job
  • Facility: University of Pittsburgh Physicians
  • Department: 60433 POP24 Plastic Surg Isalys Clin
  • Location: 3380 Blvd Of The Allies, Pittsburgh PA 15213
  • Union Position: No
  • Salary Range: $16.86 to $26.56 / hour

Description

UPMC Department of Plastic Surgery is hiring a full-time Authorization Specialist to join their team in Oakland, PA! In this position, you will work Monday-Friday from 8:00am-4:30pm. No evenings, weekends, or holidays required! 

The Authorization Specialist assists in obtaining authorizations for all surgeries, contacting insurance companies, calling patients to schedule pre-op and post-op appointments, aiding the surgery schedulers, and answering phone messages. 

Responsibilities:

 

  • 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.
  • 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.
  • Ensures accurate coding of the diagnosis, procedure, and services being rendered using ICD-9-CM, CPT, and HCPCS Level II.
  • Provides referral/pre-notification/authorization services timely to avoid unnecessary delays in treatment and reduce excessive nonclinical administrative time required of providers.
  • Submits pertinent demographic and supporting clinical data to payor to request approval for services being rendered.
  • Maintains compliance with departmental quality standards and productivity measures.
  • 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.
  • Utilizes UPMC systems and insurance payor or contracted provider web sites to perform prior authorization, edit, and denial services. Utilize authorization resources along with any other applicable reference material to obtain accurate prior authorization.
  • Resolves basic authorization edits to ensure timely claim filing and elimination of payor rejections and or denials.

 

Qualifications

  • High School diploma or equivalent and 2 years working experience in a medical environment (such as a hospital, doctor's office, or ambulatory clinic)
  • OR an 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
  • Understanding of authorization processes, insurance guidelines, third party payors, and reimbursement practices preferred
  • Experience utilizing a web-based computerized system preferred.


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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