Description

University of Pittsburgh Physicians is hiring a full time Authorization Specialist to join their Center for Fertility and Reproductive Endocrinology team at Magee-Women's Hospital in Pittsburgh! The Center for Fertility and Reproductive Endocrinology offers a woman-focused approach, knowledge, and expertise to provide highly personalized reproductive health care, including evaluation, diagnosis, and treatment. The Center provides the most recent advances in virtually all aspects of reproductive healthcare. The Center is designed to address all aspects of women's reproductive healthcare and includes psychosocial as well as medical and surgical services.

Hours for this position will be Monday through Friday, daylight hours with no evenings, weekends, or holidays! This position will offer some work-from home flexibility after completing the orientation period.

In this position you will counsel REI patients regarding the financial options related to the treatment plan., perform charging and follow-up related to the revenue cycle functions, be responsible for monitoring daily appointment schedules and financial spreadsheet for IUI cycle patients, provide financial counseling of IUI cycle costs, and collecting pre-payments. 

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.

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

Skills 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 practices

Experience 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 Inclusions 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 Resources Groups, such as PRIDE Health or UPMC ENABLED (Empowering Abilities and Leveraging Difference) Network, that support the implementation of our diversity strategy. 
 
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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