Pre-Certification Specialist: Pediatric Care Focus

UAB Medicine

Birmingham (AL)

On-site

USD 36,000 - 48,000

Full time

14 days+

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Benefits offered by this job

Educational assistance

Generous paid time off

Employee assistance program

Wellness program

Paid parental leave

PSLF eligibility

Job summary

UAB Medicine is seeking a pre-authorization specialist to obtain approvals for procedures and referrals with insurance carriers. The role requires understanding medical necessity and payer requirements across pediatric subspecialties.

You will review clinical information, justify testing, and collaborate with PMP offices to ensure timely authorizations. The organization offers comprehensive benefits and opportunities within Alabama's largest health system.

Qualifications

High school diploma or GED; degree may substitute for experience.
Extensive knowledge of medical terminology and abbreviations.
Two years’ experience in a medical setting, quality/utilization review preferred.
Knowledge of CPT, ICD-10, HCPCS, LCDs for Medicare, and Medicaid processes.
ICD-10 coding certification or CPC certificate preferred.

Responsibilities

Obtain pre-authorization for procedures and referrals required by insurance companies.
Explain and justify requested tests to insurance carriers and PMP offices.
Understand detailed medical information across pediatric subspecialties to determine medical necessity.