Medical Authorization Specialist — Denials & Pre-Auth Expert

Life in Pittsburgh; Pittsburgh (Allegheny County); On-site; USD 52,000 - 64,000; Full time

Job summary

UPMC is seeking an Authorization Specialist for the Heart and Vascular Institute at Children’s Hospital of Pittsburgh. The role is full-time, on-site, Monday–Friday 8:00am–4:30pm, with prior authorization and scheduling experience required.

Responsibilities include pre-authorizations, denial management, and revenue functions, using ICD-9-CM, CPT, and HCPCS. Strong communication skills and proficiency in Microsoft Office are essential to ensure timely, accurate authorizations.

Qualifications

• High School diploma or equivalent with 2 years in medical environment or Associate's degree with 1 year experience; Bachelor's preferred.
• Must understand medical terminology, ICD-9, CPT Codes.
• Proficient in Microsoft Office.
• Excellent communication and interpersonal skills.
• Ability to analyze data and exercise independent judgment.
• Experience with web-based computerized systems.
• Knowledge of authorization processes and payer guidelines.

Responsibilities

• Perform pre-authorizations and denials management for inpatients, outpatients, and ED.
• Review medical records to determine medical necessity and pre-authorize procedures.
• Submit demographic and clinical data to payors for approvals.
• Ensure compliance with quality standards and coordinate with Physician Services and Hospital Division.
• Utilize UPMC systems and payor websites to process authorizations, edits, and denials.
• Resolve basic authorization edits to minimize claim delays.

Skills

Medical terminology

ICD-9-CM codes

CPT codes

Microsoft Office

Communication skills

Data analysis

Independent judgment

Web-based system usage

Education

High School diploma or equivalent

Associate's degree in medical environment

Bachelor's degree (preferred)

Job description

UPMC is seeking an Authorization Specialist for the Heart and Vascular Institute at Children’s Hospital of Pittsburgh. The role is full-time, on-site, Monday–Friday 8:00am–4:30pm, with prior authorization and scheduling experience required.

Responsibilities include pre-authorizations, denial management, and revenue functions, using ICD-9-CM, CPT, and HCPCS. Strong communication skills and proficiency in Microsoft Office are essential to ensure timely, accurate authorizations.