Director, Referral/Authorization Management Job in Pittsburgh 15203, Pennsylvania US
Director, Referral/Authorization Management
UPMC Physician Services
Job ID: 2014493
University of Pittsburgh Physicians is currently seeking candidates for a full-time Director, Referral/Authorization Management to help support the Registration Scheduling Department for our Southside location. The Director provides administrative and personnel management for Referral and Authorization management within UPMC Physician Services Division. You will be responsible for providing direction and solutions for the following: pre-authorization/authorization processes, elective pre-certification, management of clinical resource utilization programs and activities to achieve cost control and optimize physician reimbursement for services provided through department processes and collaboration with other departments across the revenue cycle.
Basic Qualifications:
- Bachelor's degree required.
- Minimum of 5 years progressively responsible managerial experience with revenue cycle processes within a professional billing office or other health care environment preferred
- Experience in managing and leading high level management and analytical staff
- Ability to build credible and effective relationships with physician and executive leadership
- Understanding of referral and authorization processes. Knowledge of medical terminology, third party payor eligibility requirements, registration, scheduling, charge processing, third party payor billing requirements, reimbursement practices and regulatory guidelines
- Knowledge of health care revenue cycle processes and requirements
- Knowledge of computer software, consisting of but not limited to Microsoft Excel, Word, Access, Power Point, e-mail and experience with healthcare billing systems
- Registered Nurse licensed in the state of Pennsylvania
- PA or CRNP strongly preferred
UPMC also offers a variety of benefit options designed to provide personal security, convenience, and assistance to you and your family. With this flexibility and choice, you can decide which options best meet your needs.
We welcome you to view the complete job description and apply today at http://bit.ly/DirRefAuthorMngmt_2014493 . EOE
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About The Company
UPMC is a $10 billion global health enterprise with more than 55,000 employees headquartered in Pittsburgh, Pa., and is transforming health care by integrating more than 20 hospitals, 400 doctors’ offices and outpatient sites, a health insurance services division, and international and commercial services. Affiliated with the University of Pittsburgh Schools of the Health Sciences, UPMC is redefining health care by using innovative science, technology, and medicine to invent new models of accountable, cost-efficient, and patient-centered care. For more information on how UPMC is taking medicine from where it is to where it needs to be, go to UPMC.com.