Sr. Authorization Specialist (Hybrid) - Magee Women's Hospital

University of Pittsburgh Physicians is hiring a full-Time Sr.

Authorization Specialist to help support their UPMC Magee-Womens Center for Fertility and Reproductive Endocrinology office at Magee Women's Hospital!

Hours: Monday through Friday, daylight hours.

No evenings, weekends, or holidays!

Location: Magee Women's Hospital - 300 Halket St., Pittsburgh, PA 15213.

-- This position will be required to train at our Penn Hills office.

This position will provide some work from home flexibility, after completion of training.

Position Specifics: The Sr.

Authorization Specialist also functions as the IVF Financial counselor for the REI department.

Position is at the forefront of patient care requiring benefit verification, obtaining authorizations, and completing all revenue cycle functions to assist the patient in making crucial financial decisions regarding treatments.

The Sr.

Authorization Specialist determines financial liability based on the patient's medical benefit policy and is primarily responsible for obtaining and tracking necessary insurance authorizations for infertility services.

Requires evaluation and pre-collection of self-pay payments and outstanding REI account balances prior to services.

Direct communication with patients is critical to provide patients with financial estimates prior to treatment.

Department Details: The UPMC Magee-Womens 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.

We offer a wide range of fertility and reproductive health services, from in vitro fertilization (IVF) to genetic counseling.

Our goal is always to provide compassionate, expert care to anyone struggling with infertility.

We also offer fertility preservation options for those who may wish to delay parenthood or conceive in the future.

What Can You Bring to UPMC?

* Contribute to UPMC's mission of Life Changing Medicine * Set the standards for the level and quality of care for the care delivery team * Provide patient care activities for a group of patients and their families through the application of independent judgment, communication, and collaboration with all team members.

* Establish and maintain collaborative relationships with physicians, other health care providers, patients, and their families, to achieve desired patient outcomes throughout the continuum of care.

* Demonstrate a commitment to the community and to your health care profession What Can UPMC Do for You?

* A career path that provides you with the right experience to be successful in the position you want to obtain now and, in the future * Health and welfare benefits like medical, vision, dental, and life and disability, and an exceptional retirement program * Work life balance to help manage other important aspects of your life such as: PTO, wellness programs, paid parental leave * Competitive pay for the work that you do - base pay, merit, and premium pay Purpose: To perform authorization activities for a broader scope of inpatient, outpatient and emergency department patients, denial management and all revenue functions.

Need to demonstrate, through actions, a consistent performance standard of excellence to which all work is to conform.

The expertise of the Authorization Specialist Senior shall include an in depth working knowledge in the area of authorization related activities including pre-authorizations, notifications, edits, denials, across service areas or business units.

The Authorization Specialist Senior shall demonstrate the philosophy and core values of UPMC in the performance of duties.

Responsibilities: * General responsibilities1.

Maintains compliance with departmental quality standards and productivity measures.

2.

Works collaboratively with internal and external contacts to enhance customer satisfaction and process compliance, to avoid a negative financial impact.3.

Utilizes 18+ UPMC applications and payor/ contracted provider web sites to perform prior authorization, edit, and denial services.4.

Provides on the job training for the Authorization Specialist.5.

Utilize authorization resources along with any other applicable reference material to obtain accurate prior authorization.

* Prior authorization responsibilities1.

Reviews and interprets pertinent 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 criteria or state laws and regulations to determine medical necessity for the clinical appropriateness for a broad scope of services and procedures considered effective for the patient's illness, injury, or disease.

3.

Obtains appropriate diagnosis, procedure, and additional service codes to support medical necessity of services being rendered using pertinent medical record and ICD-CM, CPT, and HCPCS Level II resources.

4.

Submits pertinent demographic and supporting clinical data to payor to request approval for services being rendered.

5.

Provides referral/pre-notification/authorization services timely to avoid unnecessary delays in treatment and reduce excessive administrative time required of providers.

* Retrospective authorization responsibilities1.

Reviews insurance payments and remittance advice documents for proper processing and payment of authorization claims, as appropriate.

2.

Audits authorization related data errors and/or completes retro-authorizations to resolve unprocessed or denied claims.

3.

Researches denials by interpreting the explanation of benefits or remittance codes and prepares appeals for underpaid, unjustly recoded, or denied claims.

4.

Submits requests for account adjustments/controllable losses to manager in accordance with departmental process.

5.

Identifies authorization related edit/denial trends and causative factors, collates data, and provides summary of observations.

Communicates identified trends to Manager.

Qualifications: High School diploma or equivalent with 4 years working experience in a medical environment (such as a hospital, doctor's office, or ambulatory clinic) OR An Associate's degree and 2 years of experience in a medical environment required.

Bachelor's degree (B.A) preferred.

OR Completion of a medical terminology course (or equivalent) or has 3 years of experience working with medical field required Skills Required: Knowledge and interpretation of medical terminology, ICD, and CPT codes.

Proficient in Microsoft Office applications Excellent communication and interpersonal skills.

Ability to analyze data and use independent judgment.

Skills Preferred: Understanding of authorization processes, insurance regulations, third party payors, and reimbursement practices.

Experience utilizing a web-based computerized system Licensure, Certifications, and Clearances: * Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran UPMC has a Center for Engagement and Inclusions that is charged with executing leading-edge and next- generation diversity strategies to advance the organization's diversity management capability and its national presence as a diversity leader.

This includes having Employee Resources Groups, such as PRIDE Health or UPMC ENABLED (Empowering Abilities and Leveraging Difference) Network, that support the implementation of our diversity strategy.