BJC Healthcare Pre-Certification Coordinator-Therapy Services in Saint Louis, Missouri

Your Career. Made Better.

For more than 130 years, St. Louis Children's Hospital has provided exceptional care for children in all 50 states and 80 countries around the world. With its academic partner, Washington University School of Medicine, Children’s is consistently ranked among the nation’s best pediatric hospitals by U.S. News & World Report. A member of BJC Healthcare, St. Louis Children’s Hospital follows one simple mission – to do what’s right for kids. That mission comes to life through medical discovery, innovative therapies and compassionate care. In 2018, Children's expanded with a state-of-the-art, 12-story medical tower. To learn more, visit StLouisChildrens.org, Facebook, Twitter and Instagram.

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Role Purpose

Works in coordination with other departmental and hospital staff to ensure reimbursement for care rendered by facility including pre-certification with external and on-site reviewers for tests and procedures. Responsible for completing the necessary data elements in a timely and efficient manner in order to financially clear all patients prior to their scheduled visit and all inpatient encounters.

Responsibilities

  • Authorizations (inpatient, ancillary and surgery): Contacts provider offices, payors and/or payor websites to secure and validate authorization information. A review of medical records may be required if initiating the authorization request directly with a payor. Follow up on post review of insurance mismatch.

  • Complete quality review of all inpatient encounters to ensure financial clearance to avoid reimbursement delays.

  • Collaborates with case management department and third party payors to ensure timely notificaiton of inpatient encounters.

  • Utilize payor logs and various reports to ensure all authorization documentation is accurate and complete for financial clearance. Provides additional follow-up and coordination between case management and payors to obtain clinical information to finalize authorization.

Minimum Requirements

Degree

  • High School Diploma or GED

Experience

  • 2-5 years

Supervisor Experience

  • No Experience

Preferred Requirements and Additional JobInformation

Degree

  • Bachelor's Degree

ServiceSupportSkills

  • Patient Access - 2 years or more

Benefits Statement

Note: not all benefits apply to all openings

  • Comprehensive medical, dental, life insurance, and disability plan options- Pension Plan*/403(b) Plan- 401(k) plan- Tuition Assistance- Health Care and Dependent Care Reimbursement Accounts-On-Site Fitness Center (depending on location)-Paid Time Off Program for vacation, holiday and sick time

*Pension does not apply to Memorial Hospital, Memorial Hospital East, Memorial Medical Group, Alton Memorial or Parkland Health Center

Legal Statement

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

REQNUMBER: 1178722-1A