Pre-Certification Specialist-Pediatrics Administration

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. #J-18808-Ljbffr