Oncology Access & Authorization Specialist

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

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.