Pre-Certification Specialist - Pediatrics Administration (AM)

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

Position Overview

Shifts: Full-time Schedules: Monday-Friday Day Shift Entity: UA Health Services Foundation 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

Responsible for quality and efficient customer service through the daily oversight of the Pre-cert team including training, motivating and problem solving. 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

• Required: High school diploma or GED.
• 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 1 st Referral process.
• 1- 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 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.