Specialist, OP Adult Partial

at  RWJBarnabas Health

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

• 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.