Authorization Specialist | Oncology

Socket.dev; Mechanicsburg (Cumberland County); On-site; USD 45,000 - 65,000; Full time

Job summary

UPMC Hillman Cancer Center in Mechanicsburg is seeking an Authorization Specialist to manage pre-authorizations, denials, and related revenue functions. You will review records, apply payer criteria, and ensure timely approvals to support patient care.

The role requires medical terminology knowledge, coding proficiency, and strong communication. Regular hours, Monday–Friday, on-site with a compassionate oncology team.

Qualifications

• Requires high school diploma or equivalent with 2 years in a medical setting, or an associate's with 1 year.
• Completion of a medical terminology course is required.
• Proficient in medical terminology, ICD-9/CPT coding, and office software.
• Excellent communication and interpersonal skills; ability to analyze data and exercise judgment.

Responsibilities

• Manage prior authorizations, notifications, edits, and denials.
• Review medical records to determine medical necessity per payer criteria.
• Code diagnoses and procedures using ICD-9-CM, CPT, and HCPCS.
• Assist with referrals and timely authorization to avoid treatment delays.
• Collaborate with Physician Services and hospital staff to ensure compliance.

Skills

Medical terminology

ICD-9 CPT coding

MS Office

Communication skills

Analytical thinking

Education

High School diploma or equivalent

Associate's degree

Bachelor's degree preferred

Medical terminology course

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 anAuthorization Specialistat 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 Mechanicsburg, 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.

• 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
• 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

Licensure, Certifications, and Clearances

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran