Pre-Certification Specialist-Pediatrics Administration

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

Responsibilities

• Obtains pre-authorization for procedures and referrals required by insurance companies
• Performs clerical duties
• Explain and justify requested tests for various diagnoses to insurance carriers
• Referrals from PMP offices
• Thorough understanding of detailed medical information in a number of pediatric subspecialties
• Provide medical necessity for testing and referrals

Requirements

• High school diploma or GED
• Two (2) years' experience in a medical setting, quality/utilization review 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

Preferred

• Knowledge of payer requirements
• Computer (EMR, Windows, Word, Excel)
• Fax machine, copier, charts and reports
• Knowledge of pediatric testing procedures
• IDC-10 coding certification preferred

LICENSE, CERJIEICAJON AND/OR REGISTRATION

• Required: None
• Preferred: Certified Procedural Coder (CPC) certificate

Traits & Skills

• Self-directed and self-motivated
• Good communication and interpersonal skills
• 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 an 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

Qualifications

None specified

Skills

None specified