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

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