Pediatric Prior Authorization Specialist - Daytime, On-site

Novus Group; Pittsburgh (Allegheny County); On-site; USD 28,000 - 31,000; Full time

Benefits offered by this job

Day-one medical, dental, and vision

Wellness resources

No night/weekend/holiday shifts

Generous PTO and paid holidays

Employer-matched retirement plan

Job summary

Novus Group is seeking a Prior Authorization Specialist for the Pediatric Heart & Vascular Institute on-site in Pittsburgh, PA. The role focuses on medical necessity reviews, authorizations, and payer coordination to support pediatric cardiology services.

You will navigate multiple payer portals, interpret records, and ensure timely processing. The position offers a stable day schedule with full benefits and opportunities for career growth within revenue cycle management.

Qualifications

• Strong data analytical capabilities and independent clinical judgment.
• Excellent written and verbal communication skills.
• Working knowledge of payer-specific medical necessity criteria and denial management workflows.
• Experience with prior authorization and medical scheduling workflows is required.

Responsibilities

• Review and interpret clinical records to obtain pre-authorizations, pre-notifications, and referrals for pediatric cardiology services.
• Submit documentation to third-party payers via multiple portals using approved criteria and regulations.
• Resolve basic authorization edits and retrospective issues to ensure timely claim filing.
• Collaborate across departments to optimize revenue cycle workflows.

Skills

Data analysis

Clinical judgment

Written communication

Verbal communication

Payer knowledge

Education

High School Diploma or GED

Associate’s degree

Bachelor's degree preferred

Tools

Microsoft Office

Revenue cycle platforms

Job description

Novus Group is seeking a Prior Authorization Specialist for the Pediatric Heart & Vascular Institute on-site in Pittsburgh, PA. The role focuses on medical necessity reviews, authorizations, and payer coordination to support pediatric cardiology services.

You will navigate multiple payer portals, interpret records, and ensure timely processing. The position offers a stable day schedule with full benefits and opportunities for career growth within revenue cycle management.