Specialist, OP Adult PartialReq #:0000161130

Category:Clerical / Administrative Support

Status:Full-Time

Shift:Day

Facility:Trinitas Regional Medical Center

Department:OP Adult Partial Hospital

Location:

NPC PLAZA BLDG, 654 E. Jersey Street, Elizabeth, NJ 07206

Job Overview:

Position is responsible for obtaining and verifying insurance information for new and existing patients as well as updating treatment authorizations.

Qualifications:

Required:

• High School Diploma required and one-year related experience required

• Managed Care and Insurance experience required

Preferred:

• Passport software experience preferred

Scheduling Requirements:

• Shift- 8:00am-4:00pm

• Monday- Friday including Holidays

• Full Time

Essential Functions:

• Back-up support for registration and pre-intake functions as necessary

• Back-up support/coverage for SWAs, as necessary

• Obtains appropriate release of information

• Contacts insurance companies to obtain current benefit information/eligibility for patients with insurance benefits

• Contacts managed care companies to obtain initial authorization/precertification services

• Responsible for documentation and data entry on all managed care/EAP cases including information on payor status forms and timely entry into a computer data base

• Responsible for tracking and managing case activity for entire treatment process, ensuring that all services are authorized, backing this up with related documentation

• Coordinates with clinicians and physicians to obtain clinical data for continuing case review s; facilitate time completion and submission of forms to managed care companies

• Provides statistics on managed care/commercial insurance cases on a regular basis

• Prepares out of network agreements for patients with special billing arrangements and tracks service activity utilization

• Assists managing charity care caseload, as assigned

• Provide verbal update on overall status of managed care caseload to program director/designee, as requested

• Provides information and referral services to patients, as requested.

• Assist program director in identifying non-compliant clinicians and doctors

• Maintain query system in managed care database to allow for better tracking of expired authorizations or authorizations due to expire

• Enter insurance changes into system as needed

• Alert Director or assistant director of non-compliant clinicians on a weekly basis

• Verify insurance for incoming patients within 2 days.

Benefits and Perks:

At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees physical, emotional, social, and financial health.

• Paid Time Off (PTO)

• Medical and Prescription Drug Insurance

• Dental and Vision Insurance

• Retirement Plans

• Short & Long Term Disability

• Life & Accidental Death Insurance

• Tuition Reimbursement

• Health Care/Dependent Care Flexible Spending Accounts

• Wellness Programs

• Voluntary Benefits (e.g., Pet Insurance)

• Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!

Choosing RWJBarnabas Health!

RWJBarnabas Health is the premier health care destination providing patient-centered,

high-quality academic medicine in a compassionate and equitable manner, while delivering

a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.

RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.

Equal Opportunity Employer

RWJBarnabas Health is an Equal Opportunity Employer