Care Coordination & Authorization Specialist - Day Shift

UPMC; Altoona (PA); Hybrid; USD 48,000 - 66,000; Full time

Benefits offered by this job

Benefits package

Total rewards package

Job summary

UPMC Altoona Regional Health Services is seeking a full-time Managed Care Specialist to join the Altoona Station Medical Center team. The role focuses on test scheduling, pre-certifications, and coordinating patient care within the group practice.

The position requires handling incoming calls, securing prior authorizations, and maintaining clear communication with physicians, staff, and patients to ensure timely, compliant service delivery.

Qualifications

• Obtain testing prior authorizations and insurance authorizations for patients.
• Coordinate patient care in accordance with pre-certification requirements.
• Maintain documentation and communicate effectively with physicians and HIS department.

Responsibilities

• Fax requests and letters to providers or facilities.
• Obtain testing prior authorizations and insurance authorizations for patients.
• Assist with roster management as assigned.
• Answer incoming calls and relay messages promptly.
• Ensure timely flow of information to specialists, PCPs, staff and patients.
• Provide patients with complete information about tests or procedures and prep.
• Schedule diagnostic testing or procedures as needed.
• Pre-certify patient services and obtain approvals for specialties, admissions, testing, rehab and DME.
• Apply managed care product principles to duties to ensure contractual compliance.
• Update patient charts with appointment details and prep instructions.
• Inform HIS with any information that needs to be sent to consulting physician offices.
• Collaborate with manager to maintain files and support quality assurance and utilization review.

Job description

UPMC Altoona Regional Health Services is seeking a full-time Managed Care Specialist to join the Altoona Station Medical Center team. The role focuses on test scheduling, pre-certifications, and coordinating patient care within the group practice.

The position requires handling incoming calls, securing prior authorizations, and maintaining clear communication with physicians, staff, and patients to ensure timely, compliant service delivery.