Your Career. Made Better.

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 mid-Missouri regions.BJC serves patients and their families in urban, suburban and rural communities through its13 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.

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Role Purpose

Reviews payments and contractual allowances associated with HMO/PPO, Medicare, Medicaid, IPA, and Champus on inpatient and outpatient accounts to insure accurate reimbursement. Initiates appeals to third party carriers for erroneous reimbursement.


  • Reviews payments and contractual allowances.

  • Monitors reimbursements from third party carriers as defined in contractual and federal or state agreements.

  • Processes payment discrepancies and identifies variances; researches contract terms; performs analysis of discrepancies; initiates appeals and processes refunds.

  • Identifies payment discrepancy patterns, proposing resolution via managed care payor representatives, managed care contracting, billing processes, etc.

  • Participates in regular meetings with primary managed care payor representatives. Presents payment discrepancy patterns utilizing actual claim examples.

Minimum Requirements


  • High School Diploma or GED


  • <2 years

Supervisor Experience

  • No Experience

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 with company match- 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

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: 1153393-1A