Prior Auth Rep Role

Remote position, Monday–Friday, 8:00 AM–4:30 PM. No weekends or holidays. Training will be remote, 8:00 AM–4:30 PM.

About the role

This role is critical in the financial clearance process, assisting BJC hospitals enterprise-wide in securing the appropriate authorization and/or Notice Of Admission (NOA) to prevent rescheduling patients or risking net revenue loss. The position obtains authorization on behalf of physicians at Washington University School of Medicine and BJC Medical Group, maintaining positive relationships and ensuring technology supports accurate scripting and validation of authorization and NOA. The role represents BJC with the highest standard of customer service, compassion, and adherence to mission, vision, values, and service standards.

Facilitates patient entrance into BJC facilities by handling insurance validation, benefit verification, pre-certification, and financial clearance. Ensures accurate patient data, particularly authorization data and status, is populated into the patient record. This role requires exceptional attention to detail and competence with insurance carriers, Medicare guidelines, and federal, state, and accreditation agencies.

Responsibilities

• Obtain prior authorization for biopsies and other procedures, working within EPIC, communicating with insurance companies, and utilizing patient registration knowledge.
• Validate patient information, scheduled test/surgery details, and insurance information with a high degree of accuracy and attention to detail.
• Ensure authorization details in the patient’s medical record are accurate.
• Utilize critical thinking to research and resolve mismatches in information across orders, scheduling, registration, and insurance systems.
• Follow departmental processes for data capture and maintain consistent, professional communication with provider offices, insurance companies, and patients (primarily via phone for rescheduling under the Ancillary Authorization process).
• Promote teamwork and employee engagement, contributing to opportunities for improving customer satisfaction and employee engagement.
• Support the Ancillary Authorization (scheduled outpatient services), Surgery Authorization (scheduled surgical procedures), or NOA (Notice of Admission) processes within the BJC Pre-Arrival Team.
• Initiate contact with provider offices, payers, and/or payer websites, accessing various systems and tools to secure and validate authorization information.
• Review medical records when required for Ancillary Authorization requests.
• Maintain a constant state of alertness and work safely, as this is a safety-sensitive position.

Requirements

• High School Diploma or GED (required).
• 2–5 years of relevant experience (required).
• Associate’s Degree (preferred).
• 5–10 years of relevant experience (preferred).
• Certified Healthcare Access Associate (CHAA) certification (preferred).

Benefits

• Comprehensive medical, dental, vision, life insurance, and legal services available on the first day of the month after hire.
• Disability insurance paid for by BJC.
• Annual 4% BJC Automatic Retirement Contribution.
• 401(k) plan with BJC match.
• Tuition Assistance available from the first day.
• Access to the BJC Institute for Learning and Development.
• Health Care and Dependent Care Flexible Spending Accounts.
• Paid Time Off combining vacation, sick days, holidays, and personal time.
• Adoption assistance.