Pre-Authorization Representative

Aiken Regional Medical Centers; Aiken, Northern (SC, KY); Hybrid; USD 45,000 - 60,000; Full time

Benefits offered by this job

Competitive pay

Excellent health plans

Tuition reimbursement

401(k) with match

Career development opportunities

Job summary

Aiken Regional Medical Centers in Aiken, South Carolina, seeks a Pre-Authorization Specialist to identify and obtain prior authorizations for scheduled and add-on services. You will verify coverage, document in CERNER, and communicate results to physicians to prevent denials and improve satisfaction.

The role requires knowledge of insurance processing and payer requirements, with a focus on timely authorization and peer-to-peer support when needed.

Qualifications

• Associate degree in business or related field 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.

Responsibilities

• 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.

Skills

Communication skills

Detail oriented

Healthcare familiarity

Education

Associate degree in business or related major

CHAA certification

Tools

CERNER

Job description

Responsibilities

Pre-Authorization Representative

Aiken Regional Medical Centers, located in Aiken, South Carolina, is a 273-bed acute care facility providing top quality and safe healthcare to the residents of Aiken and surrounding communities since 1917. Aiken Regional Medical Centers has been ranked a top hospital in South Carolina by the American Heart Association for its treatment of heart attack, heart failure and Stroke, and most recently, coronary artery disease.

Additionally, Aiken Regional provides comprehensive healthcare services such as behavioral health (Aurora Pavilion Behavioral Health), emergency medical care (main hospital and ER at Sweetwater), orthopedic surgeries, maternity, rehabilitation services(Hitchcock Rehabilitation Services), imaging, and wound care.

Visit us online at: https://www.aikenregional.com

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.

Benefit Highlights

• Unlimited Employee Referral Bonus Program
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• Tuition/Certification Reimbursement after 6 months
• Culture of Excellence – Employee Recognition program
• Challenging and rewarding work environment
• Clinical Nursing Ladder opportunities
• SoFi student loan refinancing program
• 401(K) with company match and discounted stock plan
• Career development opportunities within UHS and its 300+ Subsidiaries!
• More information is available on our Benefits Guest Website: uhsguest.com

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune 500 corporation. Headquartered in King of Prussia, PA, UHS has 99,000 employees. Through its subsidiaries, UHS operates 28 acute care hospitals, 331 behavioral health facilities, 60 outpatient and other facilities in 39 U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

Qualifications

Requirements

• 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.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.