Prior Authorization Specialist

BJC HealthCare • Florissant, MO

1d

About The Position

BJC HealthCare is seeking a Prior Authorization Specialist to support or rehab center for PT, OT and speech therapy.
Christian Hospital has been serving St. Louis and the surrounding metro areas since 1903. U.S. News & World Report ranks Christian Hospital No. 5 in St. Louis for overall clinical excellence and No. 9 in Missouri, which puts us in the top 6% of all hospitals in the state!
The U.S. News adult methodology ranks clinical specialties and rates common care procedures and conditions. Christian was nationally ranked as “high performing” in the clinical specialty of geriatrics and in the following seven of 21 common procedures and conditions: heart attack, heart failure, kidney failure, diabetes, COPD, pneumonia and stroke. High performing in a specialty means we were in the top 10% nationally of all evaluated hospitals for that specialty or procedure and condition.
Northwest HealthCare, six miles west of Christian, offers 24- hour emergency care, the Sleep Disorders Center and a variety of outpatient diagnostic and imaging services.
This department supports the administrative functions including, but not limited to, registration, scheduling, insurance verification, and charging for the outpatient clinical rehabilitation departments at Graham Medical Center (PT, OT, Speech and Day Rehab). Staff include office assistants, a supervisor and manager.
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.

Requirements

• Applicants must have 2+ years experience in prior authorization.
• High School Diploma or GED
• 2-5 years

Nice To Haves

• Associate's Degree
• 5-10 years
• 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
• 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.

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: Entry Level
• Education Level: High school or GED
• Number of Employees: 251-500 employees