Pre-Authorization Representative
UHS
Summary
The Pre-Authorization Specialist is responsible for identifying prior authorization requirements by insurance/payer, processes, and obtains prior authorizations for scheduled and add-on services. Determines if services are a covered benefit, obtains pre-authorization and documents information in CERNER. Communicates with the ordering Provider's office if services were approved or denied and facilitates peer-to-peer reviews when needed to prevent denials and improve Physician satisfaction.
Job description
Position Description
The Pre-Authorization Specialist is responsible for identifying prior authorization requirements by insurance/payer, processes, and obtains prior authorizations for scheduled and add-on services. Determines if services are a covered benefit, obtains pre-authorization and documents information in CERNER. Communicates with the ordering Provider's office if services were approved or denied and facilitates peer-to-peer reviews when needed to prevent denials and improve Physician satisfaction.
Duties
- Locates, reviews and obtains appropriate chart documentation from all sources (Physician, CERNER, etc.) based on payer requirements needed to obtain prior authorization for scheduled/add-on IP and OP procedures/admissions/surgeries.
- Communicates with physician office regarding status of authorization, information needed, facilitates, and completes peer-to-peer reviews when needed.
- Initiate appeals for denied authorizations prior to service rendered avoiding denials and/or penalties to the facility.
- Understands Insurance processing requirements i.e. (verification, authorization, terms, requirements and regulations) and familiar with payer processes to obtain authorization in a timely manner.
Qualifications
- Associate degree in business or related major preferred and/or 5 years or more of directly related experience performing same or similar job function.
- CHAA - (Certified Healthcare Access Associate) certification preferred.
- Five (5) years' experience in a health care facility or equivalent position performing same or similar job duties required.
- Medical Terminology completion preferred, understanding of third-party payer requirements (Authorization, verification and regulations).
- Ability to receive and express detailed information through oral and written communication.
Requirements
- Five (5) years' experience in a health care facility or equivalent position performing same or similar job duties required
- Associate degree in business or related major preferred
- CHAA (Certified Healthcare Access Associate) certification preferred
- Medical Terminology completion preferred
- Understanding of third-party payer requirements (Authorization, verification and regulations)
- Ability to receive and express detailed information through oral and written communication
Benefits
- Employee Referral Bonus Program
- Competitive Compensation
- Generous Paid Time Off
- Medical, Dental & Vision
- Prescription Drug Plans
- Tuition/Certification Reimbursement
- Employee Recognition Program
- SoFi Student Loan Refinancing
- 401(k) Matching
- Discounted Stock Plan
- Career Development Opportunities
Company overview
Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected providers of hospital and healthcare services, operating as a Fortune 300 corporation headquartered in King of Prussia, Pennsylvania. Founded in 1979, UHS has grown into a major healthcare enterprise with approximately 99,000 employees and annual revenues exceeding $14 billion. The company operates through its subsidiaries, managing 29 acute care hospitals, 331 behavioral health facilities, and 60 outpatient and other facilities across 39 U.S. states, Washington D.C., Puerto Rico, and the United Kingdom. UHS provides comprehensive healthcare services including acute care, behavioral health treatment, cancer centers, and ambulatory surgical centers. The company's strategy focuses on building or acquiring high-quality hospitals in rapidly growing markets and investing in advanced medical equipment and skilled personnel to become the leading healthcare provider in each community it serves. UHS is publicly traded on the New York Stock Exchange (NYSE: UHS) and has established a strong reputation for delivering compassionate, high-quality care while maintaining financial stability and operational excellence.