COVID-19 Vaccination Information

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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   Current UPMC employees must apply in HR Direct

Authorization Specialist

  • Job ID: 788946291
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Children's Hospital of Pittsburgh
  • Department: Audiology
  • Location: 4401 Penn Avenue, Pittsburgh PA 15224
  • Union Position: No
  • Salary Range: $16.86 to $26.56 / hour

Description


To perform authorization activities of inpatient, outpatient and emergency department patients, denial management and all revenue functions. Need to demonstrate, through actions, a consistent performance standard of excellence to which all work is to conform. The expertise of the Authorization Specialist shall include working knowledge in the area of authorization related activities including pre-authorizations, notifications, edits, denials, etc.The Authorization Specialist shall demonstrate the philosophy and core values of UPMC in the performance of duties.

This position has some opportunities to work from home. 

Responsibilities:

  • Prior authorization 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 18+ UPMC system 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.
  • Retrospective authorization responsibilities
  • Resolves basic authorization edits to ensure timely claim filing and elimination of payor rejections and or denials.
  • Obtain intakes for new referrals over the phone and schedule the initial evaluation electronically.
  • Obtain insurance authorization for initial authorization for initial evaluations and walk-ins when required. Submit plans for treatment from therapists to obtain insurance authorization for ongoing appointments. Log and track all insurance authorizatio
  • Schedule ongoing therapy appointments electroncially and activate the account when the patient arrives.
  • Performs other assigned duties dependent upon location such as inventory and ordering of supplies, completion of payroll, daily logs for crash cart, temperature logs, record dept meeting minutes, etc.
  • Answers phone and receives visitors including relaying messages to appropriate staff.
  • Enters charges in Cerner within required time frames to avoid late charges. Reviews Charge Description Master and All Services Report daily and makes any necessary corrections with charge entry and registrations.

 

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 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
  • Experience utilizing a web-based computerized system.


Licensure, Certifications, and Clearances:

  • Act 31 Child Abuse Reporting
  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance

UPMC is an Equal Opportunity Employer/Disability/Veteran

COVID-19 Vaccination Information

Individuals hired into this role must comply with UPMC’s COVID vaccination requirements upon beginning employment with UPMC. Refer to the COVID-19 Vaccination Information section at the top of this page to learn more.

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Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

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