Regional Campus: Rutgers Biomedical and Health Sciences (RBHS)
Posting Number: 17ST2599
Job Type: Full Time
Rutgers, The State University of New Jersey is seeking a Billing Technician (Precertification), for the Department of Anesthesia/Pain Management at Rutgers Robert Wood Johnson Medical School.
Via Electronic Medical Record (EMR), faxes and emails, manages incoming requests for third party carrier prior authorization from the Group for testing, procedures, medications and DME. Reviews requests for compliance, accuracy and completion and initiates request using online websites, portals and telephone, in a time sensitive manner. Comprehensive documentation and relaying resolution of prior authorization requests to the departments, providers (University Radiology Group, RWJUH, community radiology providers, and pharmaceutical providers) 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 for EMR, in order to obtain an approval. Provides the physician or designee detailed instruction from the carrier on appeal of denied prior authorization for services.
Reviews the patient's EMR for accurate and complete data needed to initiate a request for prior authorization (PA) or Notifications of Services, Requests, as needed.
Completes information if the minimum data needed is not available in the chart.
Uses provided tools (at-a-glance notes, User Tables, etc.) to access the need to proceed with a PA request, based on the patient's insurance carrier.
Reviews structured clinical data in the EMR to match against specific medical terms, diagnoses and procedures codes (without need for interpretation) and follows established process for authorization request or referral for additional required information, prior to submission.
Accurately provides 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.
Verifies the eligibility of the patient's health insurance and provides appropriate requested medical records/clinical notes/test and lab results from EMR for carrier or 3rd party review.
Documents PA request resolution in EMR and supplies requestors with complete information regarding approvals or any appeals or peer-to-peer review requests for contact information, that was provided.
Ensures timely follow up or required re- work of prior authorization requests.
Performs other related duties as assigned.
Home Location Campus: Downtown New Brunswick
Knowledge of medical services coding is preferred.
Bilingual (English/Spanish)is a plus.
Required Knowledge, Skills, and Abilities:
Familiarity with medical terminology is required.
Excellent communication and organizational skills and demonstrated ability to work independently, are required.
Rutgers, The State University of New Jersey, is a leading national public research university and the state's preeminent, comprehensive public institution of higher education. Rutgers is dedicated to teaching that meets the highest standards of excellence; to conducting research that breaks new ground; and to turning knowledge into solutions for local, national, and global communities. As it was ...at our founding in 1766, the heart of our mission is preparing students to become productive members of society and good citizens of the world. Rutgers teaches across the full educational spectrum: preschool to precollege; undergraduate to graduate and postdoctoral; and continuing education for professional and personal advancement. Rutgers is New Jersey's land-grant institution and one of the nation's foremost research universities, and as such, we educate, make discoveries, serve as an engine of economic growth, and generate ideas for improving people's lives.