Clinic Services Representative I

Position Details

Position Information

Recruitment/Posting Title Clinic Services Representative I

Job Category Staff & Executive - Administrative & Support Department RHG-RWJ Pediatrics Clinic Overview

New 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.

Posting Summary

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 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 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.

Position Status Full Time Hours Per Week Daily Work Shift Work Arrangement FLSA Nonexempt Grade 1850 Position Salary Annual Minimum Salary 23.840 Annual Mid Range Salary 24.340 Annual Maximum Salary 25.070 Standard Hours 40.00 Union Description Teamsters, Local 97 Payroll Designation PeopleSoft Benefits

Rutgers offers a comprehensive benefit program to eligible employees. For details, please go to https:// uhr.rutgers.edu/benefits/benefits-overview. Rutgers also offers a benefit program to eligible full-time postdoctoral fellow students. For details, please go to https: // finance.rutgers.edu/healthcare-risk/insurance/postdoctoral-health- insurance.

Seniority Unit Terms of Appointment Staff - 12 month Position Pension Eligibility PERS

Qualifications

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.

Certifications/Licenses Required Knowledge, Skills, and Abilities

Familiarity with medical terminology.

Superior customer service.

Excellent communication and organization skills and a demonstrated ability to work independently.

Preferred Qualifications

Knowledge of medical services coding.

Equipment Utilized Physical Demands and Work Environment Special Conditions

Posting Details

Posting Number 23ST0435

Posting Open Date Special Instructions to Applicants Regional Campus Rutgers Biomedical and Health Sciences (RBHS) Home Location Campus Downtown New Brunswick City New Brunswick State NJ Location Details

Pre-employment Screenings

All offers of employment are contingent upon successful completion of all pre- employment screenings.

Immunization Requirements

Under Policy 60.1.35 Immunization Policy for Rutgers Employees and Prospective Employees, Rutgers University requires all prospective employees to provide proof that they are fully vaccinated and have received a booster (where eligible) against COVID-19 prior to commencement of employment, unless the University has granted the individual a medical or religious exemption. Employees who are not eligible for a booster at the time of an offer of employment must provide proof they have received a booster upon eligibility and upload proof of same. Under Policy 100.3.1 Immunization Policy for Covered Individuals, if employment will commence during Flu Season, Rutgers University may require certain prospective employees to provide proof that they are vaccinated against Seasonal Influenza for the current Flu Season, unless the University has granted the individual a medical or religious exemption. Additional infection control and safety policies may apply. Prospective employees should speak with their hiring manager to determine which policies apply to the role or position for which they are applying. Failure to provide proof of vaccination for any required vaccines or obtain a medical or religious exemption from the University will result in rescission of a candidate's offer of employment or disciplinary action up to and including termination.

Affirmative Action/Equal Employment Opportunity Statement

It is university policy to provide equal employment opportunity to all its employees and applicants for employment regardless of their race, creed, color, national origin, age, ancestry, nationality, marital or domestic partnership or civil union status, sex, pregnancy, gender identity or expression, disability status, liability for military service, protected veteran status, affectional or sexual orientation, atypical cellular or blood trait, genetic information (including the refusal to submit to genetic testing), or any other category protected by law. As an institution, we value diversity of background and opinion, and prohibit discrimination or harassment on the basis of any legally protected class in the areas of hiring, recruitment, promotion, transfer, demotion, training, compensation, pay, fringe benefits, layoff, termination or any other terms and conditions of employment. For additional information please see the Non-Discrimination Statement at the following web address: https:// uhr.rutgers.edu/non- discrimination-statement

Supplemental Questions

Required fields are indicated with an asterisk ().

Do you have 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?

Yes

No

Are you familiar with medical terminology?

Yes

No

Do you have experience in accessing and retrieving information from a computer database?

Yes

No

Applicant Documents

Required Documents

Resume/CV

Optional Documents

Cover Letter/Letter of Application