Senior Authorization Specialist – Remote Option

UPMC; Pittsburgh, Northern (Allegheny County, KY); Híbrido; USD 60.000 - 90.000; Jornada completa

Descripción de la vacante

UPMC in Pittsburgh is hiring a full-time Sr. Authorization Specialist to support its Care Management department. This role works Monday through Friday during daylight hours and is eligible to work from home after training, with an on-site rotation about every 5 weeks.

The Senior Authorization Specialist handles authorization activities for inpatient, outpatient, and ED patients, including pre-authorizations, denials, and revenue functions, drawing on extensive payor resources.

Responsabilidades

• Maintain compliance with departmental quality standards and productivity measures.
• Collaborate with internal and external contacts to enhance customer satisfaction and process compliance.
• Utilize 18+ UPMC applications and payer websites to perform prior authorization, edit, and denial services.
• Provide on the job training for the Authorization Specialist.
• Use authorization resources to obtain accurate prior authorization.
• Review patient history and medical records to pre-authorize procedures and ensure medical necessity.
• Determine medical necessity using payor criteria and state regulations for a broad service scope.
• Obtain diagnosis, procedure, and service codes to support medical necessity.
• Submit demographics and clinical data to payors for service approvals.
• Provide referral/pre-notification/authorization services to avoid delays.
• Review payments and remittance documents for proper processing of authorization claims.
• Audit data for errors and complete retro-authorizations to resolve denials.
• Research denials and prepare appeals for underpaid or denied claims.
• Submit adjustment requests according to departmental process.
• Identify trends in authorization edits/denials and report to management.

Descripción del empleo

UPMC in Pittsburgh is hiring a full-time Sr. Authorization Specialist to support its Care Management department. This role works Monday through Friday during daylight hours and is eligible to work from home after training, with an on-site rotation about every 5 weeks.

The Senior Authorization Specialist handles authorization activities for inpatient, outpatient, and ED patients, including pre-authorizations, denials, and revenue functions, drawing on extensive payor resources.