UPMC Department of Neurosurgery is hiring a full-time Authorization Specialist to join their team in Oakland, PA! In this position, you will work Monday-Friday from 8:00am-4:30pm. You will assist with reviewing and interpreting medical record documentation for patient history and diagnosis, submitting and obtaining authorization, scheduling testing and imaging for patients, and other office duties including scanning and faxing.

　　The UPMC Department of Neurosurgery is one of the largest Neurosurgery Departments in the United States. We interact with patients from around the globe and provide surgical care for those suffering with neurological conditions.

　　Purpose:

　　To perform authorization activities of inpatient, outpatient and emergency department patients, denial management and all revenue functions. Need to demonstrate, through actions, a consistent performance standard of excellence to which all work is to conform. The expertise of the Authorization Specialist shall include working knowledge in the area of authorization related activities including pre-authorizations, notifications, edits, denials, etc.The Authorization Specialist shall demonstrate the philosophy and core values of UPMC in the performance of duties.

　　Responsibilities:

　　Prior authorization responsibilities1. 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. 2. 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. 3. Ensures accurate coding of the diagnosis, procedure, and services being rendered using ICD-9-CM, CPT, and HCPCS Level II. 4. 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.

　　General responsibilities:1. Maintains compliance with departmental quality standards and productivity measures. 2. 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.3. Utilizes 18+ UPMC system and insurance payor or contracted provider web sites to perform prior authorization, edit, and denial services.4. Utilize authorization resources along with any other applicable reference material to obtain accurate prior authorization.

　　Retrospective authorization responsibilities1. 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-9, and CPT codes

　　Must be proficient 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.

　　Licensure, Certifications, and Clearances:

　　Act 34UPMC is an Equal Opportunity Employer/Disability/Veteran

　　UPMC has a Center for Engagement and Inclusions that is charged with executing leading-edge and next- generation diversity strategies to advance the organization’s diversity management capability and its national presence as a diversity leader. This includes having Employee Resources Groups, such as PRIDE Health or UPMC ENABLED (Empowering Abilities and Leveraging Difference) Network, that support the implementation of our diversity strategy.