UPMC
Authorization Specialist (Medical Oncology)
UPMC, Pittsburgh, Pennsylvania, us, 15289
Are you passionate about ensuring that patients receive the care they need? Do you thrive in a fast-paced environment where attention to detail is crucial? If so, we want you to be part of our team as an Authorization Specialist at UPMC Hillman Cancer Center!
At UPMC, we’re committed to providing exceptional oncology care to our community. As an Authorization Specialist, you’ll play a vital role in ensuring that patients have access to the care they deserve. Our team is dedicated to excellence, and we’re looking for someone who shares our commitment to making a difference.
Why Join Our Team?
Teamwork: At our Hillman campus in Shadyside, teamwork is at the heart of what we do. Collaborating with colleagues and providers is essential for success.
Work-Life Balance: This full-time position offers regular hours—Monday through Friday, 8:00 am to 4:30 pm. No evenings, holidays, or weekends!
Impact: Your work directly impacts patients’ lives. You’ll be part of a compassionate team dedicated to making a difference.
Ready for the challenge? Apply online today and be part of our mission to provide exceptional care at Hillman Cancer Center!
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, 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. 5. 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 systems and insurance payor or contracted provider websites to perform prior authorization, edit, and denial services.
Utilize authorization resources along with any other applicable reference material to obtain accurate prior authorization.
Resolves basic authorization edits to ensure timely claim filing and elimination of payor rejections and or denials.
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-10, and CPT codes
Must be proficient in Microsoft Office applications
Excellent communication and interpersonal skillsAbility to analyze data and use independent judgment
Understanding of authorization processes, insurance guidelines, third party payors, and reimbursement practices preferred.
Experience utilizing a web-based computerized system preferred.
Licensure, Certifications, and Clearances:
Act 34
UPMC is an Equal Opportunity Employer/Disability/Veteran
At UPMC, we’re committed to providing exceptional oncology care to our community. As an Authorization Specialist, you’ll play a vital role in ensuring that patients have access to the care they deserve. Our team is dedicated to excellence, and we’re looking for someone who shares our commitment to making a difference.
Why Join Our Team?
Teamwork: At our Hillman campus in Shadyside, teamwork is at the heart of what we do. Collaborating with colleagues and providers is essential for success.
Work-Life Balance: This full-time position offers regular hours—Monday through Friday, 8:00 am to 4:30 pm. No evenings, holidays, or weekends!
Impact: Your work directly impacts patients’ lives. You’ll be part of a compassionate team dedicated to making a difference.
Ready for the challenge? Apply online today and be part of our mission to provide exceptional care at Hillman Cancer Center!
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, 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. 5. 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 systems and insurance payor or contracted provider websites to perform prior authorization, edit, and denial services.
Utilize authorization resources along with any other applicable reference material to obtain accurate prior authorization.
Resolves basic authorization edits to ensure timely claim filing and elimination of payor rejections and or denials.
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-10, and CPT codes
Must be proficient in Microsoft Office applications
Excellent communication and interpersonal skillsAbility to analyze data and use independent judgment
Understanding of authorization processes, insurance guidelines, third party payors, and reimbursement practices preferred.
Experience utilizing a web-based computerized system preferred.
Licensure, Certifications, and Clearances:
Act 34
UPMC is an Equal Opportunity Employer/Disability/Veteran