Authorization Specialist - Magee Women's Hospital

UPMC•Pittsburgh, PA

4h•Hybrid

About The Position

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 and is designed to address all aspects of women's reproductive healthcare, including psychosocial as well as medical and surgical services. The Authorization Specialist will provide financial counseling to REI patients regarding coverage/costs for infertility treatment plans, perform charging and follow-up related to revenue cycle functions, and be responsible for monitoring daily appointment schedules and financial spreadsheets for IUI/OI cycle patients. They will also provide financial counseling of IUI/OI cycle costs, collect pre-payments and outstanding account balances, communicate with nursing teams and providers regarding outstanding balances, and answer phone calls/messages to resolve patient billing questions.

Requirements

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.
Completion of a medical terminology course (or equivalent).
Knowledge and interpretation of medical terminology, ICD-9, and CPT codes.
Proficient in Microsoft Office applications.
Excellent communication and interpersonal skills.
Ability to analyze data and use independent judgment.

Nice To Haves

Previous experience working in a medical office setting with knowledge of Epic and CPT/ICD-10 codes.
Bachelor's degree (B.A).
Understanding of authorization processes, insurance guidelines, third party payors, and reimbursement practices.
Experience utilizing a web-based computerized system.

Responsibilities

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.
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.
Ensures accurate coding of the diagnosis, procedure, and services being rendered using ICD-9-CM, CPT, and HCPCS Level II.
Provides referral/pre-notification/authorization services timely to avoid unnecessary delays in treatment and reduce excessive nonclinical administrative time required of providers.
Submits pertinent demographic and supporting clinical data to payor to request approval for services being rendered.
Maintains compliance with departmental quality standards and productivity measures.
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.
Utilizes 18+ UPMC system and insurance payor or contracted provider web sites to perform prior authorization, edit, and denial services.
Utilize authorization resources along with any other applicable reference material to obtain accurate prior authorization.
Resolves basic authorization edits to ensure timely claim filing and elimination of payor rejections and or denials.