Authorization Specialist | Oncology

UPMC; Harrisburg (Dauphin County); On-site; USD 36,000 - 54,000; Full time

Job summary

UPMC Hillman Cancer Center in Harrisburg, PA seeks an Authorization Specialist to ensure patients access necessary oncology care. In this full-time role, you will manage pre-authorizations, denials, and related revenue functions, working with physicians and payors to expedite approvals.

You will interpret medical records, apply coding standards (ICD-9-CM, CPT, HCPCS), and communicate clearly with providers, patients, and insurers.

Qualifications

• High School diploma or equivalent with 2 years medical office experience
• Associate's degree with 1 year medical environment experience; Bachelor's degree preferred
• 2-3 years medical office experience preferred
• Completion of a medical terminology course required
• Knowledge of ICD-9, CPT codes and medical terminology; proficient in Microsoft Office
• Experience with authorization processes and payor guidelines; web-based systems familiarity

Responsibilities

• Manage denials and oversee all revenue functions.
• Perform pre-authorizations, notifications, edits, and denials.
• Code diagnoses, procedures, and services using ICD-9-CM, CPT, and HCPCS Level II.
• Provide referral/pre-notification/authorization services to avoid delays.
• Submit demographic and clinical data to payors to request approvals.
• Collaborate with Physician Services and Hospital Division to ensure compliance and satisfaction.
• Utilize 18+ UPMC systems for prior authorization, edits, and denials.
• Handle retrospective authorization tasks to minimize delays.

Skills

Medical terminology

ICD-9/CPT codes

Microsoft Office

Communication

Data analysis

Independent judgment

Authorization processes

Web-based system

Education

High School diploma or equivalent

Associate's degree

Bachelor's degree preferred

Tools

UPMC system

Job description

Are you passionate about ensuring patients receive the care they 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 an 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 responsibilities1. 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)
• 2-3 years of medical office experience preferred.
• Completion of a medical terminology course (or equivalent) required
• Skills 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
• Skills Preferred:
  • Understanding of authorization processes, insurance guidelines, third party payors, and reimbursement practicesExperience utilizing a web-based computerized system.

Licensure, Certifications, and Clearances:

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran