Prior Authorization Specialist at BJC HealthCare

St. Louis, Missouri, United States -

Full Time

Start Date

Immediate

Expiry Date

16 May, 26

Salary

0.0

Posted On

15 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Financial Clearance, Authorization, Notice Of Admission, Insurance Validation, Benefit Verification, Pre-certification, Data Accuracy, Attention To Detail, Critical Thinking, Communication, Customer Service, Teamwork, Ancillary Authorization, Surgery Authorization, Medical Records Review

Industry

Hospitals and Health Care

Description

Additional Information About the Role Siteman Cancer Center is looking for an Prior Authorization Specialist! Monday - Friday Remote Position No Weekends or Holidays 8am - 4:30pm Overview Barnes-Jewish Hospital at Washington University Medical Center is the largest hospital in Missouri and is ranked as one of the nation's top hospitals by U.S. News & World Report. Barnes-Jewish Hospital's staff is composed of full-time academic faculty and community physicians of Washington University School of Medicine, supported by a house staff of residents, interns, fellows and other medical professionals. Recognizing its excellence in nursing care, Barnes-Jewish Hospital was the first adult hospital in Missouri to be certified as a Magnet Hospital by the American Nurses Credentialing Center. Staff in the Radiation Oncology Department work with leading experts from the Siteman Cancer Center, the first and only National Cancer Institute designated comprehensive cancer center in the St. Louis region.¿ With a staff of approximately 250 medical and allied health professionals, the department of Radiation Oncology offers its hospital staff the opportunity to work in a cutting-edge environment focused solely on delivering exceptional and uncompromising patient care. Preferred Qualifications Role Purpose 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 U 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. Without the above we are limited in our collection of payment. The role represent BJC with the highest standard of customer service, compassion and perform 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). This team member must communicate in a professional manner with particular emphasis on positive and respectful interaction with patients and offices. They must also be able to provide consistent excellent customer service in a variety of situations. The ability to promote teamwork and employee engagement is everyone's responsibility. This team member will work to create an atmosphere of teamwork by contributing to opportunities to improve employee engagement and customer satisfaction. In all situations, they will engage others in a respectful and collaborative manner. They will seek opportunities for self-development (personal and technical) while achieving department objectives and goals. This position is part of a multidisciplinary team which provides authorization support for multiple BJC Hospitals. 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, this team member 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 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, vison, 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 To learn more, go to our Benefits Summary. *Not all benefits apply to all jobs The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job. Equal Opportunity Employer

Responsibilities

This role is critical for securing appropriate authorization or Notice of Admission (NOA) to prevent rescheduling patients or losing net revenue, requiring accurate data population and validation across various systems. Responsibilities include facilitating insurance validation, benefit verification, pre-certification, and financial clearance while maintaining positive relationships with providers and payers.