PRE-AUTHORIZATION REPRESENTATIVE

UHS•Washington, DC

About The Position

The Pre-Authorization Specialist identifies prior authorization requirements by insurer or payer and processes and obtains authorizations for scheduled and add-on services. The role determines whether services are covered benefits, obtains pre-authorizations, and records information in CERNER and EPIC. The specialist communicates approval or denial decisions to ordering providers’ offices and facilitates peer-to-peer reviews when needed to help prevent denials and improve physician satisfaction. George Washington University Hospital is a 395-bed tertiary care academic medical center in downtown Washington, DC, operated by Universal Health Services, Inc. (UHS). The hospital provides care in areas including trauma, neonatal intensive care, cardiac care, cancer, neurosciences, women’s health, and advanced surgery.

Requirements

Associate degree in business or a related major.
Five years of experience in a health care facility or an equivalent position performing the same or similar duties.

Nice To Haves

CHAA (Certified Healthcare Access Associate) certification.

Responsibilities

Identify prior authorization requirements by insurance or payer.
Process and obtain prior authorizations for scheduled and add-on services.
Determine whether services are covered benefits.
Document authorization information in CERNER and EPIC.
Communicate approval or denial decisions to ordering providers’ offices.
Facilitate peer-to-peer reviews when needed to prevent denials and improve physician satisfaction.