UPMC is hiring a full-time Authorization Specialist to support their Center for Fertility and Reproductive Endocrinology team at UPMC Magee Women's Hospital! The Center for Fertility and Reproductive Endocrinology offers a woman-focused approach, knowledge, and expertise to provide highly personalized reproductive health care, including evaluation, diagnosis, and treatment. The Center provides the most recent advances in virtually all aspects of reproductive healthcare. The Center is designed to address all aspects of women's reproductive healthcare and includes psychosocial as well as medical and surgical services.
The Authorization Specialist will -
- Provide financial counseling to REI patients regarding coverage/costs for infertility treatment plan
- Perform charging and follow-up related to the revenue cycle functions.
- Be responsible for monitoring daily appointment schedules and financial spreadsheet for IUI/OI cycle patients, provide financial counseling of IUI/OI cycle costs, collecting pre-payments and outstanding account balances.
- Communicate with nursing teams and providers regarding outstanding balances.
- Answer phone calls/messages to resolve patient billing questions.
This position will work Monday through Friday, 7:00am to 3:30pm, with no evenings, weekends, or holidays. This position will work 3 days in office, 2 days work from home per week. Previous experience working in a medical office setting with knowledge of Epic and CPT/ICD-10 codes is preferred
Responsibilities:
- Prior authorization responsibilities1. Reviews and interprets medical record documentation for patient history, diagnosis, and previous treatment plans to pre-authorize insurance plan determined procedures to avoid financial penalties to patient, provider and facility. 2. Utilizes payor-specific approved criteria or state laws and regulations to determine medical necessity or the clinical appropriateness for inpatient admissions, outpatient facility, office services, durable medical equipment, and drugs in terms of type, frequency, extent, site and duration, and considered effective for the patient's illness, injury, or disease. 3. Ensures accurate coding of the diagnosis, procedure, and services being rendered using ICD-9-CM, CPT, and HCPCS Level II. 4. Provides referral/pre-notification/authorization services timely to avoid unnecessary delays in treatment and reduce excessive nonclinical administrative time required of providers. 5. Submits pertinent demographic and supporting clinical data to payor to request approval for services being rendered.
- General responsibilities:1. Maintains compliance with departmental quality standards and productivity measures. 2. Works collaboratively with internal and external contacts specifically, Physician Services and Hospital Division, across UPMC as well as payors to enhance customer satisfaction and process compliance, ensuring the seamless coordination of work and to avoid a negative financial impact.3. Utilizes 18+ UPMC system and insurance payor or contracted provider web sites to perform prior authorization, edit, and denial services.4. Utilize authorization resources along with any other applicable reference material to obtain accurate prior authorization.
- Retrospective authorization responsibilities1. Resolves basic authorization edits to ensure timely claim filing and elimination of payor rejections and or denials.
- High School diploma or equivalent with 2 years working experience in a medical environment (such as a hospital, doctor's office, or ambulatory clinic) OR
- An Associate's degree and 1 year of experience in a medical environment required. (Bachelor's degree (B.A) preferred)
- Completion of a medical terminology course (or equivalent) required
Skills Required: Knowledge and interpretation of medical terminology, ICD-9, and CPT codesMust be proficient in Microsoft Office applications Excellent communication and interpersonal skillsAbility to analyze data and use independent judgmentSkills Preferred: Understanding of authorization processes, insurance guidelines, third party payors, and reimbursement practicesExperience utilizing a web-based computerized system.
Licensure, Certifications, and Clearances:
UPMC is an Equal Opportunity Employer/Disability/Veteran
