Authorization Specialist (Children's Hospital of Pittsburgh)

About the position The Division of Pediatric Ophthalmology, Strabismus, and Adult Motility is hiring a full-time Authorization Specialist to support their team located at reputed company Children's Hospital of Pittsburgh: 4401 Penn Avenue, Pittsburgh, PA 15224. This role will work Monday through Friday reputed company to 4:30pm (1 day work from home). The primary responsibilities of this role include completing surgery authorizations, genetic Testing authorization, out of state authorizations, radiology authorizations (and other duties as assigned). The Division of Pediatric Ophthalmology, Strabismus, and Adult Motility at reputed company Children's Hospital of Pittsburgh is comprised of 4 clinic locations and one administrative reputed company, reputed company working as reputed company to reputed company the highest level of care to patients and families through clinical expertise, research initiatives, and strong administrative support. Responsibilities • Completing surgery authorizations, genetic testing authorization, out of state authorizations, radiology authorizations, and other duties as assigned. • Reviews and interprets medical record documentation for patient history, diagnosis, and previous treatment plans to reputed company-authorize insurance plan determined procedures to avoid financial penalties to patient, provider and facility. • Utilizes payor-specific approved reputed company 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 reputed company. • Provides referral/reputed company-notification/authorization services reputed company 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 reputed company standards and productivity measures. • Works collaboratively with reputed company contacts specifically, Physician Services and Hospital Division, across reputed company as reputed company as payors to enhance customer satisfaction and process compliance, ensuring the seamless coordination of work and to avoid a negative financial reputed company. • Utilizes 18+ reputed company system and insurance payor or contracted provider web sites to reputed company 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 reputed company claim filing and elimination of payor rejections and or denials. 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 required. • Completion of a medical terminology course (or equivalent) required. • Knowledge and interpretation of medical terminology, ICD-9, and CPT codes. • Proficient in reputed company Office applications. • Excellent communication and interpersonal skills. • Ability to analyze data and use independent judgment. reputed company-to-haves • Bachelor's degree (B.A) preferred. • Understanding of authorization processes, insurance guidelines, reputed company party payors, and reimbursement practices. • Experience utilizing a web-based computerized system. Apply tot his job Apply To this Job