Prior Authorization Specialist - Ancillary - (FT Days)

Location: Remote

Schedule: Monday - Friday, 8:30 AM - 5:00 PM (No weekends or holidays)

About the role

This role is critical in the financial clearance process, assisting BJC hospitals enterprise-wide in securing 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 while maintaining positive relationships. It ensures technology supports accurate scripting and validation of authorization and NOA. The role upholds BJC’s highest standards of customer service, compassion, and alignment with the organization’s mission, vision, values, and service standards.

Facilitates components of patient entrance into any BJC facility, including insurance validation, benefit verification, pre-certification, and financial clearance. Ensures accurate patient data, particularly authorization data and status, is obtained and populated into the patient record. Requires exceptional attention to detail and competence with insurance carriers, Medicare guidelines, and federal, state, and accreditation agencies.

Responsibilities

• Validate patient information, scheduled tests, and surgeries with a high level of accuracy and attention to detail.
• Secure appropriate authorization and/or Notice Of Admission (NOA) to prevent revenue loss or patient rescheduling.
• Maintain positive relationships with physicians at Washington University School of Medicine and BJC Medical Group.
• Ensure technology accurately supports scripting and validation of authorization and NOA processes.
• Perform insurance validation, benefit verification, pre-certification, and financial clearance for patients.
• Populate and maintain accurate patient data, particularly authorization status, in the patient record.
• Stay knowledgeable and competent with insurance carriers, Medicare guidelines, and federal, state, and accreditation requirements.

Qualifications

Preferred Qualifications: Experience in financial clearance, insurance authorization, or a related healthcare administrative role.