Pre-Certification Specialist-Pediatrics Administration

Position Description Schedule: Monday-Friday Day Shift Location: Avondale Business Center Benefits: 100% tuition assistance, wellness initiatives, generous paid time off, paid parental leave, Public Service Loan Forgiveness Program eligible employer, plus more. In addition to our many benefits and perks, UAB Medicine provides a variety of resources to support employees both personally and professionally. Performs a variety of duties related to obtaining pre-authorization for procedures and referrals required by insurance companies. Duties may include but are 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. Position Requirements Required: 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 First 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 preferred. Licensing and Certification Preferred: Certified Procedural Coder (CPC) certificate. Traits & Skills Must be self-directed, self-motivated; must have good communication and interpersonal skills. Must be able to: perform a variety of duties often changing from one task to another of a different nature without loss of efficiency or composure; accept responsibility for the direction, control and planning of one's own work; work independently; recognize the rights and responsibilities of patient confidentiality; convey empathy and compassion to those experiencing pain, physical or emotional distress and/or grief; relate to others in a manner which creates a sense of teamwork and cooperation; communicate effectively with people from every socioeconomic, cultural and educational background; exhibit flexibility and cope effectively in an ever-changing, fast-paced healthcare environment; perform effectively when confronted with emergency, critical, unusual or dangerous situations; demonstrate the quality work ethic of doing the right thing the right way; maintain a customer focus and strive to satisfy the customer's perceived needs. UA Health Services Foundation (UAHSF) is proud to be an AA/EOE/M/F/Vet/Disabled employer. #J-18808-Ljbffr