Rutgers, The State University of New Jersey is seeking a Clinical Services Representative I for the Ambulatory Care department within the Rutgers, Robert Wood Johnson Medical School.
The Clinical Services Representative I performs administrative tasks as assigned to support effective and efficient office operations; mainly Prior Authorizations via Electronic Medical Records (EMR), fax and emails. Manages incoming requests for third party carriers, prior authorizations for testing, procedures, medications and DME. Reviews requests for compliance, accuracy and completion and initiates requests using online websites, portals, and telephone in a time sensitive manner. Comprehensive documentation and relaying resolution of prior authorization requests to the department providers, external providers and entities, and patients as appropriate. Providing appeal or peer-to-peer contact information, when necessary. Responsible for timely re-work of pending requests for approval and/or providing any required additional information from the EMR in order to obtain an approval. Provides the physician or designee detailed instruction from the carrier on appeal of denied prior authorizations for services.
Among the key duties of this position are the following:
Manages requests from physicians, clinical staff, hospitals, community providers and pharmacies using exemplary customer service skills.
Reviews the patient's EMR for accurate and complete data needed to initiate a request for Prior Authorization of Notification of Services. Requests any additional information needed to obtain Prior Authorization. Uses provided tools (at –a glance notes, User Tables, etc.) to access the need to proceed with a Prior Authorization request based on the patient's insurance.
Reviews structured clinical data in the EMR to match against specific medical terms, diagnoses and procedure codes (without need for interpretation) and follows established process for authorization requests or referrals for additional required information prior to submission for Prior Authorization request.
Accurately provides required information from the EMR to third party carrier, clinical and lay-person representatives using the appropriate modality of internet portals, websites, and call centers to begin the Prior Authorization process as outlined and defined by the insurance carrier/third party vendor. Verifies the eligibility of the patient's health insurance.
Competently performs the following financial functions based on assignment: Scheduling, pre-registration, recording patient arrival, administering financial and HIPAA paperwork, obtaining necessary signatures, receiving referral and precertification numbers; performs online insurance verification to assist patient with their payment options.
Minimum Education and Experience:
Four (4) years of general office billing experience, three (3) years of which shall have been in a medical billing setting, including management of various types of insurance billing processes and Pre-Authorizations.
Experience in accessing and retrieving information from a computer database.
Required Knowledge, Skills, and Abilities:
Familiarity with medical terminology.
Superior customer service skills.
Excellent communication and organization skills and a demonstrated ability to work independently.
Knowledge of medical services coding.
Posting Number: 21ST1080
Location: Downtown New Brunswick
Internal Number: 131406
About Rutgers University
Rutgers, The State University of New Jersey, is a leading national public research university and the state's preeminent, comprehensive public institution of higher education. Rutgers is dedicated to teaching that meets the highest standards of excellence; to conducting research that breaks new ground; and to turning knowledge into solutions for local, national, and global communities. As it was at our founding in 1766, the heart of our mission is preparing students to become productive members of society and good citizens of the world. Rutgers teaches across the full educational spectrum: preschool to precollege; undergraduate to graduate and postdoctoral; and continuing education for professional and personal advancement. Rutgers is New Jersey's land-grant institution and one of the nation's foremost research universities, and as such, we educate, make discoveries, serve as an engine of economic growth, and generate ideas for improving people's lives.