Job Description

St. Mary’s is a 229-bed, acute care hospital located in Enid, OK.  St. Mary’s Regional Medical Center has served the healthcare needs of northwest Oklahoma for more than 100 years.  We host more than 125 highly skilled physicians offering specialties in Cardiology, Neurology, Orthopedics, Emergency Medicine, Rehabilitation, Laboratory, Women’s Imaging, Wound Care, and more.  

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Position 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 Duties/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.
• Maintains a detailed payer log to document authorization requirements by procedure.
• Understands Insurance processing requirements i.e., (verification, authorization, terms, requirements and regulations) and familiar with payer processes to obtain authorization in a timely manner.

Benefits:

• Tuition Assistance
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision, Prescription Drug Plans & 401k with company match
• Discounts with local St. Mary’s providers

For more benefit information UHS Benefits Service Center

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. states, Washington, D.C., Puerto Rico and the United Kingdom.

Requirements:

• High school diploma or GED required.
• Associate degree in business or related major preferred.
• Certified Healthcare Access Associate (CHAA) 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

It is the policy of the Facility to provide equal opportunity in employment to all employees and applicants for employment.  No person will be discriminated against in employment on the basis any legally protected characteristics such as race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, age (40 and over or as otherwise defined by applicable law), disability or genetic information (including family medical history) or protected veteran status, or any other characteristic protected by applicable Federal, State, or local law.  For purposes of this policy, race includes traits historically associated with race, including but not limited to, hair type, texture, length and protective hairstyles (including but not limited to, braids, locks, twists, Bantu knots, hair coverings, etc.).  If certain workspaces require such restrictions for health and safety reasons, non-discriminatory accommodations should be considered and implemented if feasible.

Notice

At UHS and all subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates with matching skillset and experience with the best possible career at UHS and our subsidiaries.  We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail etc. If you feel suspicious of a job posting or job-related email, let us know by contacting us at: or 1-800-852-3449.

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