Authorization Specialist | Oncology

UPMC; Colonial Park (PA); On-site; USD 46,000 - 58,000; Full time

Job summary

UPMC Hillman Cancer Center in Harrisburg is seeking an Authorization Specialist to ensure patients receive timely access to care. The role focuses on pre-authorizations, denials management, and accurate coding across ICD-9-CM, CPT, and HCPCS, supporting a compassionate oncology team.

The position emphasizes collaboration with Physician Services and Hospital Division, with regular hours Monday through Friday and no evenings or weekends. Join a mission-driven team dedicated to patient care.

Qualifications

• Experience with pre-authorizations and denials processes.
• Ability to interpret medical records and determine medical necessity.
• Experience coding using ICD-9-CM, CPT, and HCPCS Level II.
• Strong compliance with quality standards and productivity measures.
• Collaborates with physicians and hospital divisions; strong customer service.

Responsibilities

• Reviews and interprets medical records to pre-authorize procedures.
• Determines medical necessity using payor criteria and regulations.
• Ensures accurate coding of diagnoses and services (ICD-9-CM, CPT, HCPCS).
• Provides referral/pre-notification/authorization timely to avoid delays.
• Submits demographic and supporting clinical data to payor to request approvals.

Skills

Prior authorization

Denials management

Attention to detail

Collaboration

Job description

Are you passionate about ensuring patients receive the care we need? Do you excel in a fast-paced environment where attention to detail is crucial? If so, we invite you to join our team as Authorization Specialist at UPMC Hillman Cancer Center!

At UPMC, we are dedicated to providing exceptional oncology care to our community. As an Authorization Specialist, you will play a vital role in ensuring patients have access to the care they deserve. We are looking for someone who shares our commitment to excellence and making a difference.

Key Responsibilities

• Manage denials and oversee all revenue functions.
• Demonstrate a high standard of excellence in all work.
• Utilize expertise in authorization-related activities, including pre-authorizations, notifications, edits, and denials.

Why Join Our Team?

• Teamwork: At our medical oncology office in Harrisburg, collaboration with colleagues and providers is essential for success.
• Work-Life Balance: This full-time position offers regular hours - Monday through Friday. No evenings, holidays, or weekends!
• Impact:Your work directly impacts patients’ lives. You will be part of a compassionate team dedicated to making a difference.

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.