Prior Authorization Rep Role

BJC HealthCare • Creve Coeur, MO

2d • Onsite

About The Position

The Pain Management Center at Barnes Jewish West County provides patients experiencing chronic pain with the best experience possible in all aspects of care including office visits, procedures and pharmaceutical management. When visiting the pain management center, patients are seen by RN's specializing in pain management for all of their educational needs, additional support is available between appointments by telephone triage RN's. Use of an electronic medical record allows staff to have a comprehensive understanding of each patient, patients to have access to their medical records from home, and prescriptions and other communication to be sent instantaneously to other members of the healthcare team.

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.

Requirements

• High School Diploma or GED
• 2-5 years experience

Nice To Haves

• Associate's Degree
• 5-10 years experience
• CHAA

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.
• 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.
• 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.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED