Specialist, OP Adult Partial Req #: 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 requiredManaged Care and Insurance experience required

Preferred:

Passport software experience preferred

Scheduling Requirements:

Shift- 8:00am-4:00pmMonday- Friday including HolidaysFull Time

Essential Functions:

Back-up support for registration and pre-intake functions as necessaryBack-up support/coverage for SWAs, as necessaryObtains appropriate release of informationContacts insurance companies to obtain current benefit information/eligibility for patients with insurance benefitsContacts managed care companies to obtain initial authorization/precertification servicesResponsible for documentation and data entry on all managed care/EAP cases including information on payor status forms and timely entry into a computer data baseResponsible for tracking and managing case activity for entire treatment process, ensuring that all services are authorized, backing this up with related documentationCoordinates with clinicians and physicians to obtain clinical data for continuing case review s; facilitate time completion and submission of forms to managed care companiesProvides statistics on managed care/commercial insurance cases on a regular basisPrepares out of network agreements for patients with special billing arrangements and tracks service activity utilizationAssists managing charity care caseload, as assignedProvide verbal update on overall status of managed care caseload to program director/designee, as requestedProvides information and referral services to patients, as requested.Assist program director in identifying non-compliant clinicians and doctorsMaintain query system in managed care database to allow for better tracking of expired authorizations or authorizations due to expireEnter insurance changes into system as neededAlert Director or assistant director of non-compliant clinicians on a weekly basisVerify 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 InsuranceDental and Vision InsuranceRetirement PlansShort & Long Term DisabilityLife & Accidental Death InsuranceTuition ReimbursementHealth Care/Dependent Care Flexible Spending AccountsWellness ProgramsVoluntary 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