Job Description

Pre-Authorization Specialist

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.

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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. 

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.

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We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information.

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

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