Pre-Certification Specialist-Pediatrics Administration

UAB Medicine; Birmingham (AL); On-site; USD 36,000 - 48,000; Full time

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.

Skills

Medical terminology

CPT coding

ICD-10 coding

HCPCS coding

Documentation

EMR software

Education

High school diploma or GED

Tools

EMR

Windows

Microsoft Word

Microsoft Excel

Fax machine

Copier

Job description

Position Overview

Schedules: Monday-Friday Day Shift

Entity: UA Health Services Foundation

Location: Avondale Business Center

Benefits and perks available for eligible positions include: robust educational assistance programs, generous paid time off, employee assistance and wellness programs, paid parental leave, qualifying employer for the Public Service Loan Forgiveness (PSLF) Program, plus more.

Job Description

Performs a variety of duties related to obtaining pre-authorization for procedures and referrals required by insurance companies. Duties may include but not limited to clerical duties, explanation and justification of requested test for various diagnoses to the insurance carriers and referrals from PMP offices. The position must have a thorough understanding of detailed medical information in a number of pediatric subspecialties, in order to provide medical necessity for testing and referrals.

Qualifications

High school diploma or GED. Degree can substitute for experience. Extensive knowledge of Medical terminology and abbreviations. Basic computer skills. Knowledge of Common Procedural Terminology (CPT); ICD-10; Health Care Procedural Coding System (HCPCS); Local Coverage Determinations (LCD) for Medicare; documentation guidelines for medical service provision and Medicaid Patient 1st Referral process. Two (2) years’ experience in a medical setting, quality/utilization review experience. Preferred: Knowledge of payer requirements, computer (EMR, Windows, Word, Excel) fax machine, copier, charts and reports. Knowledge of pediatric testing procedures. ICD-10 coding certification, or Certified Procedural Coder (CPC) certificate preferred.

Why Work at UAB Medicine

We are UAB Medicine, Alabama’s largest and most comprehensive health system, recognized nationally for delivering world-class patient care, pioneering research, and cutting-edge medical education. We proudly serve more than 1.2 million patients each year – from every county in Alabama, all 50 states, and many countries around the world. Our network spans numerous hospitals, emergency departments, more than 67 other sites of care, and a team of over 3,100 physicians. Our key facilities include UAB Hospital – ranked the No. 1 hospital in Alabama by U.S. News & World Report and home to the state’s first ACS-verified Level I adult trauma center and only Magnet-designated hospital – along with UAB Hospital-Callahan Eye and five UAB St. Vincent’s hospitals serving central Alabama.

UAB Medicine offers careers across a wide range of practice environments, from our internationally renowned academic medical center and award-winning community hospitals to our primary and specialty care clinics across the state. Whether you’re seeking the fast-paced learning environment of a tertiary care setting or the close-knit environment of a community facility, there’s a place for you on our team where you can become part of a mission-driven organization committed to delivering life-changing care. With nearly every medical specialty represented and unlimited opportunities for growth, you’ll find the right fit for your skills and career goals. We care for you by offering comprehensive, industry-leading benefit packages to support the individual preferences and circumstances of our diverse staff.