Pre-Cert Lead: Pediatric Referrals & Medical Necessity

UAB Medicine; Birmingham (AL); On-site; USD 40,000 - 65,000; Full time

Benefits offered by this job

Education assistance

Paid time off

Employee wellness programs

Paid parental leave

PSLF eligibility

Plus more

Job summary

UAB Medicine in Birmingham, AL, seeks a detail-oriented candidate to lead the Pre-certification team, ensuring timely authorization for procedures and referrals. The role emphasizes training, motivation, and problem solving to maintain high-quality customer service and efficient workflow.

You will work with pediatric subspecialties to explain and justify tests to insurers and manage related clerical duties.

Qualifications

• High school diploma or GED or equivalent.
• Extensive knowledge of medical terminology and abbreviations.
• Basic computer skills including EMR and Microsoft Office.
• Knowledge of CPT, ICD-10, HCPCS; LCD for Medicare; Medicaid referral guidelines.

Responsibilities

• Oversee the Pre-certification team to ensure quality and timely authorizations.
• Provide training, motivation, and problem solving for staff.
• Handle clerical duties and communicate with insurance carriers and PMP offices.
• Understand pediatric subspecialty testing to justify medical necessity for testing and referrals.

Skills

Medical terminology

Abbreviations

Basic computer skills

Payer requirements knowledge

Education

High school diploma or GED

Tools

EMR

MS Word

MS Excel

Job description

UAB Medicine in Birmingham, AL, seeks a detail-oriented candidate to lead the Pre-certification team, ensuring timely authorization for procedures and referrals. The role emphasizes training, motivation, and problem solving to maintain high-quality customer service and efficient workflow.

You will work with pediatric subspecialties to explain and justify tests to insurers and manage related clerical duties.