Prior Authorization Representative Express Scripts Jobs

Memorial Hospital is looking for a Part Time Prior Auth Rep for their Sleep Disorders Center.

This is a part time role only for 24 benefit eligible, 3 days a week from 7-4:30. Training is on-site for about 4 weeks. Job duties include patient registration, handling surgery prior authorizations, scheduling appointments, etc.

Memorial Hospital Belleville is an acute care hospital offering medical and surgical services plus critical and emergency care including Children's at Memorial for pediatric emergency care. It provides patients a full complement of diagnostic and treatment services as well as heart and vascular care. Memorial, offering medical and surgical services plus critical care, is an accredited Chest Pain Center with PCI by the Society of Cardiovascular Patient Care and is designated as an Acute Stroke Ready Hospital by the Illinois Department of Public Health. In addition, Memorial Belleville recently was accredited by the American College of Radiology as a designated Lung Cancer Screening Center. Since 2008, it has been designated as a Magnet®-recognized organization for nursing excellence by the American Nurses Credentialing Center.

Memorial Hospital Shiloh, a 94-bed, all-private suite hospital was recognized with Magnet status in 2018 and provides emergency care, labor & delivery, nursery, medical and surgical services plus critical care.

The Sleep Disorders Center conducts sleep tests and provides treatments for a variety of sleep disorders. Our testing is supervised by a registered polysomnographic tech and interpreted by a physician with special training in sleep medicine. Sleep Studies are done exclusively on an outpatient basis.

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 represents 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.

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.

Education: High School Diploma or GED

Experience: 2-5 years

Education: Associate's Degree

Experience: 5-10 years

Licenses & Certifications: CHAA

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
• 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

To learn more, go to our Benefits Summary.

*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