Clinical Services Representative I

Posting Summary
Rutgers the State University of New Jersey is seeking a Clinical Services Representative I for the Neurosurgery Department within Robert Wood Johnson Medical School. The RWJMS Clinical Services Representative I; performs administrative tasks as assigned to support effective and efficient office operations. Manages in coming 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 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. Provide patient check-in insurance verification and collect payment. Timely completes work queue tasks. Among the key duties of the position are the following: Manage requests from physicians clinical staff hospitals community providers and pharmacies using exemplary customer service skills. Review the patients EMR for accurate and complete data needed to initiate a requestfor Prior Authorization of Notification of Services. Request any additional information needed to obtain Prior Authorization. Use providedtools (at a- glance notes User Tables etc.) to access the need to proceed with a Prior Authorization request based on the patients 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 by the insurance carrier/third party vendor. Verify the eligibility of the patients 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 pre- certification numbers; performs online insurance verification to assist patient with their payment options. Provide appropriate requested medical records/clinical notes test and lab results from EMR for carrier or 3rd party review.

Overview
New Jerseys 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 UniversityNew 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 stateat Rutgers UniversityNew 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 Newarks University Hospital in Newark and other affiliates. Through this community of healers scientists and scholars Rutgers is equipped as never before to transform lives. OBGYN Clinic: add beth dillon and Sharda Kohli

Preferred Qualifications
Knowledge of medical services coding preferred