Prior Authorization Specialist - Ancillary

BJC HealthCare • St. Louis, MO

24d • Remote

About The Position

The Prior Authorization Specialist supports BJC HealthCare’s financial clearance process by securing appropriate authorizations and Notices of Admission (NOAs) for services at BJC facilities. The role helps prevent patient rescheduling and revenue loss, and may obtain authorizations on behalf of physicians at Washington University School of Medicine and BJC Medical Group. It facilitates aspects of patients’ entry into BJC facilities, including insurance validation, benefit verification, precertification, and financial clearance, while ensuring accurate patient and authorization information is recorded in the patient record.

This position is part of a multidisciplinary BJC Pre-Arrival Team supporting authorization processes for multiple hospitals. Depending on assignment, the specialist may handle scheduled outpatient services, scheduled surgical procedures, or NOA processes. The work involves contacting provider offices and payers, using payer websites and other systems, and, for some ancillary authorizations, reviewing medical records. The specialist is expected to maintain knowledge of insurance carriers, Medicare guidelines, and applicable federal, state, and accreditation requirements, and to represent BJC with professional, compassionate customer service.

Training is onsite for one week; the position is remote afterward. The schedule is Monday through Friday, 8:30 a.m. to 5:00 p.m. BJC identifies this as a safety-sensitive position, requiring the ability to remain alert and work safely.

Requirements

• High school diploma or GED.
• 2–5 years of experience.
• Exceptional attention to detail and a high degree of accuracy.
• Critical-thinking skills to research and resolve mismatches in information.
• Professional, respectful communication and consistent customer service.
• Knowledge and competence with insurance carriers, Medicare guidelines, and applicable federal, state, and accreditation agencies.
• Ability to work in a constant state of alertness and in a safe manner.

Nice To Haves

• Associate's degree.
• 5–10 years of experience.
• Certified Healthcare Access Associate (CHAA) certification.

Responsibilities

• Obtain appropriate authorizations and/or Notices of Admission for services at BJC facilities.
• Facilitate insurance validation, benefit verification, precertification, and financial clearance.
• Ensure accurate patient, scheduled service, insurance, and authorization information is entered in the patient record.
• Research and resolve discrepancies across orders, scheduling, registration, and insurance systems.
• Follow departmental processes for data capture.
• Communicate professionally and respectfully with provider offices, insurance companies, and patients, including calls related to rescheduling appointments within the ancillary authorization process.
• Contact provider offices and payers, use payer websites, and access systems and tools to secure and validate authorization information.
• Review medical records when required to initiate ancillary authorization requests directly with a payer.
• Contribute to teamwork, employee engagement, customer satisfaction, and departmental objectives.
• Seek opportunities for personal and technical self-development.

Benefits

• Medical, dental, vision, and life insurance, and legal services available the first day of the month after hire.
• Disability insurance paid for by BJC.
• Annual 4% BJC Automatic Retirement Contribution.
• 401(k) plan with BJC match.
• Tuition assistance available on the first day.
• BJC Institute for Learning and Development.
• Health Care and Dependent Care Flexible Spending Accounts.
• Paid Time Off combining 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