UPMC · 13 hours ago
Authorization Specialist, Digestive Health Care - Shadyside
Pittsburgh, PA
Full-time
Onsite
Entry Level
1+ years expUPMC Digestive Health Care is hiring a full-time Authorization Specialist to join their team at Shadyside Medical Building, Pittsburgh. In this role, you will assist with reviewing medical records, obtaining authorizations, and scheduling testing for patients, while also being cross-trained for other medical office duties as needed.
BiotechnologyHealth CareHospitalMedical
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, 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
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
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 system and insurance payor or contracted provider web sites 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
Qualification
Required
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
Completion of a medical terminology course (or equivalent) 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
Act 34
Preferred
Bachelor's degree (B.A.) preferred
Understanding of authorization processes, insurance guidelines, third party payors, and reimbursement practices
Experience utilizing a web-based computerized system
Company
UPMC
UPMC is one of the leading nonprofit health systems in the United States. A $10 billion integrated global health enterprise headquartered
10001+ employees
H1B Sponsorship
UPMC has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (3)
2024 (7)
2023 (4)
2022 (7)
2021 (7)
2020 (13)
Funding
Current Stage
Late StageTotal Funding
$0.46MKey Investors
Appalachian Regional Commission
2024-09-18Grant· $0.46M
Leadership Team
Leslie Davis
Chief Executive Officer
Frederick M. Hargett
Chief Financial Officer
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