BJC HealthCare
Mid Campus Center is looking to hire a PRN Prior Authorization Rep for their Ambulatory Services!
Overview
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) in order to prevent rescheduling the patient or risking net revenue loss. This position is required to obtain authorization on behalf of some physicians at Washington University School of Medicine and BJC medical group and must maintain positive relationships. This position ensures technology is built in a way 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 our mission, vision, values, and service standards. Facilitates certain components of the patients' entrance into any BJC facility, including insurance validation, benefit verification, pre‑certification & financial clearance. Responsible for ensuring that 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 & maintain knowledge & competence with insurance carriers, Medicare guidelines & federal, state & accreditation agencies. Responsibilities
Requires a high level of attention to detail along with a high degree of accuracy. Key components of the process include validation of the following: patient information, scheduled test/surgery information, and insurance information. Ensures that the authorization detail placed in the patient's medical record is accurate. Expected to utilize critical thinking skills to research and resolve any mismatch in information which could involve various orders/scheduling, registration and insurance systems. Additionally, departmental processes around data capture must be followed and appropriate communication is a key. This position has high visibility and interaction with provider offices, insurance companies, as well as some patient interaction (typically phone calls for rescheduling appointments under the scope of the Ancillary Authorization process). They must communicate in a professional manner with particular emphasis on positive and respectful interaction with patients and offices and provide consistent excellent customer service in a variety of situations. They will work to create an atmosphere of teamwork by contributing to opportunities to improve employee engagement and customer satisfaction, engaging others in a respectful and collaborative manner, and seeking opportunities for self‑development to achieve department objectives and goals. This position is part of a multidisciplinary team which provides authorization support for multiple BJC Hospitals and may be responsible for supporting the Ancillary Authorization (scheduled outpatient services), Surgery Authorization (scheduled surgical procedures), or the NOA (Notice of Admission) processes within the BJC Pre‑Arrival Team. As part of the authorization process, they will initiate contact with provider offices, payers and/or payer websites as well as access a variety of systems and tools to secure and validate authorization information. For Ancillary Authorizations, a review of medical records may be required if initiating the authorization request directly with a payer. BJC has determined this is a safety‑sensitive position; the ability to work in a constant state of alertness and in a safe manner is an essential function of this job. Minimum Requirements
Education: High School Diploma or GED. Experience: 2–5 years. Preferred Requirements
Education: Associate's Degree. Experience: 5–10 years. Licenses & Certifications: CHAA. Additional Preferred Requirements:
Day time PRN Shift ,
Working hours 8‑5 ,
Flexibility with start time ,
Cover PTO and FMLA, and fill‑in when needed ,
Prior authorization experience, EPIC, and insurance experience ,
Daily Pay . Benefits and Legal Statement
BJC Total Rewards: At BJC we're committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well‑being. Comprehensive medical, dental, vision, life insurance, and legal services available first day of the month after hire date Disability insurance paid for by BJC Annual 4% BJC Automatic Retirement Contribution 401(k) plan with BJC match Tuition Assistance available on first day BJC Institute for Learning and Development Health Care and Dependent Care Flexible Spending Accounts Paid Time Off benefit combines vacation, sick days, holidays and personal time Adoption assistance Benefits Summary
Not all benefits apply to all jobs. Seniority level
Entry level Employment type
Full‑time Job function
Health Care Provider Industries
Hospitals and Health Care Equal Opportunity Employer.
#J-18808-Ljbffr
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) in order to prevent rescheduling the patient or risking net revenue loss. This position is required to obtain authorization on behalf of some physicians at Washington University School of Medicine and BJC medical group and must maintain positive relationships. This position ensures technology is built in a way 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 our mission, vision, values, and service standards. Facilitates certain components of the patients' entrance into any BJC facility, including insurance validation, benefit verification, pre‑certification & financial clearance. Responsible for ensuring that 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 & maintain knowledge & competence with insurance carriers, Medicare guidelines & federal, state & accreditation agencies. Responsibilities
Requires a high level of attention to detail along with a high degree of accuracy. Key components of the process include validation of the following: patient information, scheduled test/surgery information, and insurance information. Ensures that the authorization detail placed in the patient's medical record is accurate. Expected to utilize critical thinking skills to research and resolve any mismatch in information which could involve various orders/scheduling, registration and insurance systems. Additionally, departmental processes around data capture must be followed and appropriate communication is a key. This position has high visibility and interaction with provider offices, insurance companies, as well as some patient interaction (typically phone calls for rescheduling appointments under the scope of the Ancillary Authorization process). They must communicate in a professional manner with particular emphasis on positive and respectful interaction with patients and offices and provide consistent excellent customer service in a variety of situations. They will work to create an atmosphere of teamwork by contributing to opportunities to improve employee engagement and customer satisfaction, engaging others in a respectful and collaborative manner, and seeking opportunities for self‑development to achieve department objectives and goals. This position is part of a multidisciplinary team which provides authorization support for multiple BJC Hospitals and may be responsible for supporting the Ancillary Authorization (scheduled outpatient services), Surgery Authorization (scheduled surgical procedures), or the NOA (Notice of Admission) processes within the BJC Pre‑Arrival Team. As part of the authorization process, they will initiate contact with provider offices, payers and/or payer websites as well as access a variety of systems and tools to secure and validate authorization information. For Ancillary Authorizations, a review of medical records may be required if initiating the authorization request directly with a payer. BJC has determined this is a safety‑sensitive position; the ability to work in a constant state of alertness and in a safe manner is an essential function of this job. Minimum Requirements
Education: High School Diploma or GED. Experience: 2–5 years. Preferred Requirements
Education: Associate's Degree. Experience: 5–10 years. Licenses & Certifications: CHAA. Additional Preferred Requirements:
Day time PRN Shift ,
Working hours 8‑5 ,
Flexibility with start time ,
Cover PTO and FMLA, and fill‑in when needed ,
Prior authorization experience, EPIC, and insurance experience ,
Daily Pay . Benefits and Legal Statement
BJC Total Rewards: At BJC we're committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well‑being. Comprehensive medical, dental, vision, life insurance, and legal services available first day of the month after hire date Disability insurance paid for by BJC Annual 4% BJC Automatic Retirement Contribution 401(k) plan with BJC match Tuition Assistance available on first day BJC Institute for Learning and Development Health Care and Dependent Care Flexible Spending Accounts Paid Time Off benefit combines vacation, sick days, holidays and personal time Adoption assistance Benefits Summary
Not all benefits apply to all jobs. Seniority level
Entry level Employment type
Full‑time Job function
Health Care Provider Industries
Hospitals and Health Care Equal Opportunity Employer.
#J-18808-Ljbffr