BJC is looking to hire a Remote Prior Authorization Representative.
Preferred Requirements:
Remote Monday - Friday
8:30-5 PM
No weekends or holidays
On-site training
Preferred experience: EPIC, insurance verification, working with referrals and prior authorizations
Overview
BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $6.3 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long‑term care and hospice.
BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development.
BJC's patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes‑Jewish Hospital and St. Louis Children’s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country.
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) to prevent rescheduling patients or risking net revenue loss. The position obtains authorization on behalf of physicians at Washington U School of Medicine and BJC medical group, maintains positive relationships, and ensures technology is built to support accurate scripting and validation of authorization and NOA. The role represents BJC with the highest standard of customer service, compassion and performs all duties consistently with our mission, vision, values and service standards. It facilitates patient entrance into any BJC facility, including insurance validation, benefit verification, pre‑certification and financial clearance. Responsibilities include ensuring accurate patient data, particularly authorization data, is obtained and populated into the patient record and maintaining knowledge of insurance carriers, Medicare guidelines and relevant agencies.
Responsibilities
Requires high attention to detail and accuracy: validate patient information, scheduled test/surgery details, and insurance information. Ensure authorization details in the patient's medical record are accurate and resolve mismatches involving orders, scheduling, registration, and insurance systems. Communicate professionally with provider offices, insurance companies, and patients. Provide excellent customer service, promote teamwork, and engage in continuous improvement. Support Ancillary Authorization, Surgery Authorization, or NOA processes within the BJC Pre‑Arrival Team. Initiate contact with provider offices, payers, and payer websites to secure and validate authorization information. Review medical records if initiating authorization directly with a payer. This is a safety‑sensitive position requiring constant state of alertness.
Minimum Requirements
Education: High School Diploma or GED.
Experience: 2‑5 years.
Preferred Experience: 5‑10 years. Prefer Associate’s Degree.
Licenses & Certifications: CHAA.
Benefits and Legal Statement
BJC Total Rewards:
Comprehensive medical, dental, vision, life insurance, and legal services available 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 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