You can use a pressure washer by itself, or some sort of chemical to soften stuff up first, followed by a blast from a decent garden hose a few minutes later.
I have used bleach (1 oz/gal), Physan (1 tsp/gal), but now use ZeroTol in their hose-end sprayer.
Personally, I prefer to just use the pressure washer and be done with it, then use the Zero-Tol as a preventive every six weeks.