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The Speech Pathology Department at Children's Hospital of Pittsburgh is hiring an Authorization Specialist to work at the main hospital location in Lawrenceville.

The Authorization Specialist manages authorizations for inpatient, outpatient, and emergency patients, along with denial management and revenue functions. Responsibilities include pre-authorizations, notifications, edits, and denials, while upholding UPMC's core values and high-performance standards.

Responsibilities:

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+ Review and interpret medical records to pre-authorize insurance-determined procedures, preventing financial penalties.

+ Apply payor criteria or state regulations to confirm medical necessity for admissions, outpatient services, office visits, equipment, and drugs.

+ Ensure accurate coding using ICD-9-CM, CPT, and HCPCS Level II.

+ Provide timely referrals, pre-notifications, and authorizations to avoid treatment delays and reduce administrative burden.

+ Submit demographic and clinical data to payors for service approval.

+ Collaborate with internal teams and payors to ensure compliance and seamless coordination.

+ Use UPMC systems and payor websites for prior authorizations, edits, and denials.

+ Resolve authorization edits to prevent claim delays and denials.

+ Handle new referral intakes, schedule evaluations, and obtain insurance authorizations for initial and ongoing therapy.

+ Log and track authorizations; schedule therapy appointments and activate accounts upon arrival.

+ Perform location-based duties (inventory, payroll, logs, meeting minutes).

+ Answer phones, greet visitors, and relay messages.

+ Enter charges in Cerner promptly, review and correct Charge Description Master and All Services Report daily.

+ 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

+ Knowledge and interpretation of medical terminology, ICD-9, and CPT codes.

+ Proficiency in Microsoft Office applications.

+ Excellent communication and interpersonal skills.

+ Ability to analyze data and use independent judgment.

+ Understanding of authorization processes, insurance guidelines, third party payors, and reimbursement practices.

+ Experience utilizing a web-based computerized system.Licensure, Certifications, and Clearances:

+ Clearances with renewal:

+ Act 31, 33, 34, 73

UPMC is an Equal Opportunity Employer/Disability/Veteran