Role Description 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 performs 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. Qualifications - High School Diploma or GED - 2-5 years of experience - Preferred: Associate's Degree - Preferred: 5-10 years of experience - Licenses & Certifications: CHAA Requirements - 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 - 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. - Communication is 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. - Ability to promote teamwork and employee engagement. - This position is part of a multidisciplinary team which provides authorization support for multiple BJC Hospitals. - May be responsible for supporting the Ancillary Authorization, Surgery Authorization, or the NOA processes within the BJC Pre-Arrival Team. - 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. Benefits - Comprehensive medical, dental, vision, 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.

• Independently assess and prescribe for patients in line with clinical risk assessments and in-house prescribing protocols. • Deliver safe, evidence-based prescribing within your scope of competence. • Maintain accurate and comprehensive clinical documentation. • Apply sound clinical judgement to every prescribing decision. • Escalate clinical concerns appropriately to Senior or Lead Prescribers. • Participate in clinical governance, audits, and quality improvement initiatives. • Contribute to a supportive, collaborative, and high-performing clinical team.

• Performing drug utilization review for initial determinations and/or appeals. • Collaborating as an integral member of the pharmacy team. • Ensuring the timely execution of all drug reviews in compliance with accreditation and regulatory standards. • Identifying any utilization review trends and areas of improvement.

• Under the direction of the Director or Manager the pharmacist assumes responsibility for the pharmacotherapy outcomes of patients through knowledge and skills coupled with innovative technology and the packaging and distribution of medications. • Serves as a point of contact for the patient and their family, other pharmacists (internally or externally), clients, and/or other healthcare providers to address medication related problems (MRPs), other medication or health-related issues, and/or answer questions regarding pharmacotherapy needs, medication dispensing, issues, and suggestions. • Explains care plan options and the use, side effects, and contraindications of medications dispensed, either verbally and/or via written records, stored within proprietary software. • Ensures that patient care decisions and actions as well as coding/billing are properly documented using proprietary software system. • Ensures accurate, efficient, timely and compliant medication distribution and fulfillment for patients using proprietary software. • Plans, implements, and maintains procedures for assessing, compounding, packaging, and labeling medications, according to policy and legal requirements, to ensure quality, security, and proper disposal. • Oversee Pharmacy Technicians to ensure appropriate medication reconciliation, physician order entry, inventory management, medication storage and security conditions, and medication labelling and packaging as well as compliance to company policies and procedures and regulatory guidelines. • Provides timely review, preparation/compounding, and final approval for prescription orders and dispensed medications ensuring the correct drug, dosage form, directions, quantity, days’ supply, number of refills and packaging/labelling, including ancillary warnings, is entered into the appropriate patient profile, and dispensed to the correct patient. • Works to ensure proper and compliant billing and record keeping of medications dispensed and shipped. • Uses professional judgment to provide timely, accurate and appropriate pharmaceutical care appropriately assessing new medication requests and refills making recommendations, in writing or via telephone to care providers to enhance patient outcomes and/or safety as needed in relation to care plans, changes, issues, and education. • Ensures compliance to state and federal laws and applicable rules and regulations as well as internal policies and procedures required for pharmacy practice. • Reports and works to rectify or prevent any incidents of QAs, HIPAA violations, Fraud, Waste and Abuse or other problems or violations. • Embody AnewHealth’s Core Values in all communications and interactions. Other duties as assigned.