Prior Authorization Specialist - Ancillary

Location: Remote
Schedule: Monday - Friday 8:30 AM - 5:00 PM

About the role

BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $6.3 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.

This role is critical in the financial clearance process which assists BJC hospitals enterprise-wide in securing the appropriate authorization and/or Notice Of Admission (NOA) to prevent rescheduling the patient or risking net revenue loss. The position ensures technology is built to accurately support the scripting and validation of authorization and NOA. The role represents BJC with the highest standard of customer service, compassion, and performs all duties in a manner consistent with the organization’s mission, vision, values, and service standards.

Facilitates components of the patients' entrance into any BJC facility, including insurance validation, benefit verification, pre-certification, and financial clearance. Responsible for ensuring the most accurate patient data is obtained and populated into the patient record, particularly authorization data and status. This team member must possess exceptional attention to detail and maintain knowledge and competence with insurance carriers, Medicare guidelines, and federal, state, and accreditation agencies.

Responsibilities

• Requires a high level of attention to detail along with a high degree of accuracy in validating patient information, scheduled test/surgery information, and insurance information.
• Ensures that authorization details placed in the patient’s medical record are accurate.
• Utilizes critical thinking skills to research and resolve mismatches in information involving various orders, scheduling, registration, and insurance systems.
• Follows departmental processes around data capture and communication.
• Interacts professionally with provider offices, insurance companies, and patients (typically via phone for rescheduling appointments under the Ancillary Authorization process).
• Promotes teamwork and employee engagement by contributing to opportunities that improve engagement and customer satisfaction.
• Engages others in a respectful and collaborative manner while seeking opportunities for self-development.
• Supports the Ancillary Authorization (scheduled outpatient services), Surgery Authorization (scheduled surgical procedures), or the NOA (Notice of Admission) processes within the BJC Pre-Arrival Team.
• Initiates contact with provider offices, payers, and/or payer websites, and accesses a variety of systems and tools to secure and validate authorization information.
• Reviews medical records if initiating the authorization request directly with a payer for Ancillary Authorizations.
• Works in a constant state of alertness and in a safe manner, 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).
• Certification in Healthcare Access Associate (CHAA) (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.
• Health Care and Dependent Care Flexible Spending Accounts.
• Paid Time Off benefit combining vacation, sick days, holidays, and personal time.
• Adoption assistance.