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Specialty Testing/Therapy Authorization Coordinator

  • Job ID: 589891139
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: Monday - Friday, Daylight
  • Shift: Day Job
  • Facility: UPMC Community Medicine Incorporated
  • Department: 57412 MULTI Tri Rivers Admin
  • Location: 7500 Brooktree Road, Wexford PA 15090
  • Union Position: No
  • Salary Range: $14.71 to $22.47 / hour

Description

UPMC Community Medicine is currently hiring a Regular, Full-Time Authorization team member to support the Rheumatology Division within Tri Rivers Musculoskeletal Centers located in Cranberry/Mars, PA! This is a full-time position with shifts ranging Monday - Friday during daylight hours. 

Purpose:
This position will be responsible for processing and ordering Rheumatology medications and infusion treatments. 


Responsibilities:

  • Working with insurance companies to obtain authorizations for specialty medications 
  • Staying up to date on formulary changes 
  • Working with pharmacies to obtain medications that are not specialty drugs but may still require a prior authorization 
  • Working with clinical staff in obtaining proper documentation in order to receive approval to prescribe specialty medications 
  • Work with clinical staff and physicians in the appeals process in the event of a denial 
  • Contacts patients regarding authorization and testing and follow-up appointments.
  • Addresses patient messages using proper protocol to conclusion.
  • Works in conjunction with additional Specialty Authorization Team members to assure consistent coverage for patients in regards to authorizing all categories of testing, procedure and medication therapies.
  • Schedules patient testing with specific facilities utilizing hospital/facility protocols and processes.
  • Obtains appropriate insurance authorizations for MRI/CT testing for all insurance carriers.
  • Performs other duties as needed and directed by management, team leader or physician.
  • Observes HIPAA and other privacy practices.
  • Obtains PT referrals as needed for specific carriers for external facilities.

     

Qualifications

  • High School diploma or GED.
  • One year experience in a similar position.
  • Medical office experience preferred.
  • Knowledge of current operating system (Misys) and EMR system (SRS).
  • Knowledge of the Navinet system for health care administration.
  • Knowledge of Microsoft Word and its functions.
  • Knowledge of telephone equipments and its functions (transferring, placing on hold, etc)
  • Knowledge of basic office procedures.
  • Skill in utilizing all above systems to achieve essential job functions.
  • Skill in verbal and written communications.


Licensure, Certifications, and Clearances:

  • Act 34

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

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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