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Clinic Services Representative I

Company: Rutgers University
Location: New Brunswick
Posted on: March 16, 2023

Job Description:

Rutgers, The State University of New Jersey is seeking a Clinical Services Representative I for the Pediatrics Clinic within the Robert Wood Johnson Medical School.The RWJMS 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 carrier prior authorizations for testing, procedures, medications and DME . Reviews request for compliance, accuracy and completion and initiate requests using online websites, portals, and telephone in a time sensitivemanner. 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. Provide 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: Manage requests from physicians, clinical staff, service skills. Review the patient's EMR for accurate and complete data needed to initiate a request for Prior Authorization of Notification of Services. Request any additional information needed to obtain Prior Authorization. Use provided tools (at glance notes, User Tables, etc.) to access the need to proceed with a Prior Authorization request based on the patient's insurance. Review structured clinical data in the EMR to match against specific medical terms, diagnoses and procedure codes (without need for interpretation) and follow established process for authorization request or referral for additional required information prior to submission for Prior Authorization request. Accurately provide 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 ed by the insurance carrier/third party vendor. Verify 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. Accessing and retrieving information from a computer database. Required Knowledge, Skills, and Abilities Familiarity with medical terminology. Superior customer service. Excellent communication and organization skills and a demonstrated ability to work independently. OverviewNew Jersey's academic health center, Rutgers Biomedical and Health Sciences ( RBHS ) takes an integrated approach to educating students, providing clinical care, and conducting research, all with the goal of improving human health. Aligned with Rutgers University-New Brunswick and collaborating university wide, RBHS includes eight schools, a behavioral health network, and five centers and institutes that focus on cancer treatment and research, neuroscience, advanced biotechnology and medicine, environmental and occupational health, and health care policy and aging research.Our faculty are teachers, clinicians, and scientists with unparalleled experience who advance medical innovation and provide patient care informed by the latest research findings. We offer an outstanding education in medicine, dentistry, pharmacy, public health, nursing, biomedical research, and the full spectrum of allied health careers.Our clinical and academic facilities are located throughout the state-at Rutgers University-New Brunswick, including Piscataway; and at locations in Newark, Scotch Plains, Somerset, Stratford, and other locations. Clinical partners include Robert Wood Johnson University Hospital in New Brunswick, Newark's University Hospital in Newark, and other affiliates.Through this community of healers, scientists, and scholars, Rutgers is equipped as never before to transform lives.

Keywords: Rutgers University, New Brunswick , Clinic Services Representative I, Sales , New Brunswick, New Jersey

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