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BJC
Saint Louis, MO | Full Time
$39k-48k (estimate)
2 Weeks Ago
Prior Authorization Specialist
BJC Saint Louis, MO
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$39k-48k (estimate)
Full Time | Wholesale 2 Weeks Ago
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BJC is Hiring a Prior Authorization Specialist Near Saint Louis, MO

Additional Information About the Role

Great Opportunity!

Interested in remote work!? BJC is looking for an individual with strong scheduling and patient registration skills!! 

  • Fully Remote 
  • M- F and no weekends or Holidays 
  • 8:30-5 PM 
  • Preferred exeperience: working with Prior Authorizations, EPIC, Excel, experience with Insurance providers. 
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) in order to pevent 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 the 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
    • Pension Plan*/403(b) Plan funded by BJC
    • 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 www.bjctotalrewards.com/Benefits

    *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

    Job Summary

    JOB TYPE

    Full Time

    INDUSTRY

    Wholesale

    SALARY

    $39k-48k (estimate)

    POST DATE

    05/16/2024

    EXPIRATION DATE

    05/17/2025

    WEBSITE

    bjc.co.th

    HEADQUARTERS

    New York, NY

    SIZE

    25 - 50

    INDUSTRY

    Wholesale

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    The following is the career advancement route for Prior Authorization Specialist positions, which can be used as a reference in future career path planning. As a Prior Authorization Specialist, it can be promoted into senior positions as an Admitting Supervisor that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Prior Authorization Specialist. You can explore the career advancement for a Prior Authorization Specialist below and select your interested title to get hiring information.

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    If you are interested in becoming a Prior Authorization Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Prior Authorization Specialist for your reference.

    Step 1: Understand the job description and responsibilities of an Accountant.

    Quotes from people on Prior Authorization Specialist job description and responsibilities

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    04/09/2022: Laramie, WY

    Receive requests for pre-authorizations and ensure that they are properly and closely monitored.

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    Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.

    02/27/2022: Wichita, KS

    Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.

    04/08/2022: Altus, OK

    Reported to supervisor to assure accurate capture of services needing authorization.

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    Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.

    Career tips from people on Prior Authorization Specialist jobs

    Prior Authorization Specialist must have excellent computer skills including Excel, Word, and Internet use.

    02/12/2022: New Britain, CT

    A good Prior Authorization Specialist are those who are detail oriented with above average organizational skills.

    03/28/2022: Galveston, TX

    Basic understanding of human anatomy, specifically musculoskeletal would also give you benefits for this role.

    04/04/2022: Lebanon, PA

    Some experience in medical billing or insurance authorization are strongly preferred by most employers.

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    Licenses and certifications are not usually required to work as a prior authorization specialist.

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    Step 3: View the best colleges and universities for Prior Authorization Specialist.

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