Job Description

Job Title: Authorization Specialist
Job ID: 726857
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility:
Department: POP18 PEDS Rheumatology
Location: 4401 Penn Avenue, Pittsburgh PA 15224

Description

The University of Pittsburgh Physician's is hiring an Authorization Specialist to support the Rheumatology department at Children's Hospital during daylight hours on Monday through Friday.

In this role, you will perform authorization activities of inpatient, outpatient and rheumatology department patients, denial management, and all revenue functions. The expertise of the Authorization Specialist will include working knowledge in the area of authorization related activities, including pre-authorizations, notifications, edits, denials, and more. 

Responsibilities:
  • Work 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.
  • Utilize 18+ UPMC system and insurance payor or contracted provider web sites to perform prior authorization, edit, and denial services. .
  • Review 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.
  • Ensure accurate coding of the diagnosis, procedure, and services being rendered using ICD-9-CM, CPT, and HCPCS Level II.
  • Provide referral/pre-notification/authorization services timely to avoid unnecessary delays in treatment and reduce excessive nonclinical administrative time required of providers.
  • Submit pertinent demographic and supporting clinical data to payor to request approval for services being rendered.
  • Resolve basic authorization edits to ensure timely claim filing and elimination of payor rejections and or denials.

Qualifications

  • High School diploma or equivalent with two years working experience in a medical environment (such as a hospital, doctors office, or ambulatory clinic) OR an Associates degree and one year of experience in a medical environment required. (Bachelors 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 31 Clearance
  • Act 33 Child Clearance with Renewal
  • Act 34 Criminal Clearance with Renewal
  • Act 73 FBI Clearance

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $15.13 to $23.82

Union Position: No

Apply Current Employee?

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



Now more than ever, YOU can help us shape our communities and UPMC into a better place for everyone to work, study, play, and thrive.

Learn more about working here and check out our policies and recent updates.

Share:
Talent Network