Oncology Prior Authorization Specialist

UPMC; Colonial Park (PA); On-site; USD 46,000 - 58,000; Full time

Job summary

UPMC Hillman Cancer Center in Harrisburg is seeking an Authorization Specialist to ensure patients receive timely access to care. The role focuses on pre-authorizations, denials management, and accurate coding across ICD-9-CM, CPT, and HCPCS, supporting a compassionate oncology team.

The position emphasizes collaboration with Physician Services and Hospital Division, with regular hours Monday through Friday and no evenings or weekends. Join a mission-driven team dedicated to patient care.

Qualifications

• Experience with pre-authorizations and denials processes.
• Ability to interpret medical records and determine medical necessity.
• Experience coding using ICD-9-CM, CPT, and HCPCS Level II.
• Strong compliance with quality standards and productivity measures.
• Collaborates with physicians and hospital divisions; strong customer service.

Responsibilities

• Reviews and interprets medical records to pre-authorize procedures.
• Determines medical necessity using payor criteria and regulations.
• Ensures accurate coding of diagnoses and services (ICD-9-CM, CPT, HCPCS).
• Provides referral/pre-notification/authorization timely to avoid delays.
• Submits demographic and supporting clinical data to payor to request approvals.

Skills

Prior authorization

Denials management

Attention to detail

Collaboration

Job description

UPMC Hillman Cancer Center in Harrisburg is seeking an Authorization Specialist to ensure patients receive timely access to care. The role focuses on pre-authorizations, denials management, and accurate coding across ICD-9-CM, CPT, and HCPCS, supporting a compassionate oncology team.

The position emphasizes collaboration with Physician Services and Hospital Division, with regular hours Monday through Friday and no evenings or weekends. Join a mission-driven team dedicated to patient care.