UPMC · 9 hours ago
Authorization Specialist
Pittsburgh, PA
Full-time
Onsite
Entry Level
1+ years expUPMC is a healthcare provider that is hiring an Authorization Specialist to work in the Speech Pathology Department at Children's Hospital of Pittsburgh. The role involves managing authorizations for various patient types and includes responsibilities such as pre-authorizations, denial management, and ensuring compliance with insurance requirements.
BiotechnologyHealth CareHospitalMedical
Responsibilities
Review and interpret medical records to pre-authorize insurance-determined procedures, preventing financial penalties
Apply payor criteria or state regulations to confirm medical necessity for admissions, outpatient services, office visits, equipment, and drugs
Ensure accurate coding using ICD-9-CM, CPT, and HCPCS Level II
Provide timely referrals, pre-notifications, and authorizations to avoid treatment delays and reduce administrative burden
Submit demographic and clinical data to payors for service approval
Collaborate with internal teams and payors to ensure compliance and seamless coordination
Use UPMC systems and payor websites for prior authorizations, edits, and denials
Resolve authorization edits to prevent claim delays and denials
Handle new referral intakes, schedule evaluations, and obtain insurance authorizations for initial and ongoing therapy
Log and track authorizations; schedule therapy appointments and activate accounts upon arrival
Perform location-based duties (inventory, payroll, logs, meeting minutes)
Answer phones, greet visitors, and relay messages
Enter charges in Cerner promptly, review and correct Charge Description Master and All Services Report daily
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
Proficiency in Microsoft Office applications
Excellent communication and interpersonal skills
Ability to analyze data and use independent judgment
Understanding of authorization processes, insurance guidelines, third party payors, and reimbursement practices
Experience utilizing a web-based computerized system
Clearances with renewal: Act 31, 33, 34, 73
Preferred
Bachelor's degree (B.A) preferred
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
President and CEO
Frederick M. Hargett
Chief Financial Officer
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