Pittsburgh, PA30+ days ago
Bachelor's degree (B.A preferred Completion of a medical terminology course (or equivalent required Skills Required: Knowledge and interpretation of medical terminology, ICD-9, and CPT codesMust be proficient in Microsoft Office applications Excellent communication and interpersonal skillsAbility to analyze data and use independent judgmentSkills Preferred: Understanding of authorization processes, insurance guidelines, third party payors, and reimbursement practicesExperience utilizing a web-based computerized system. 2. 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.