Regional Campus: Rutgers Biomedical and Health Sciences (RBHS)
Posting Number: 17ST1671
Job Type: Full Time
Rutgers School of Dental Medicine, Faculty Practice is seeking a Surgical Representative to serve as primary staff liaison with all surgery patients from initial physician recommendation for surgery until surgery is completed. Provides financial planning and service to patients and physicians to facilitate the scheduling and performance of surgical procedures; provides support paperwork and documentation to patients and physicians; maintains awareness of various insurance carrier’s restrictions to assure all necessary criteria are met prior to surgery (insurance carriers to include HMOs, commercial PPOs, Medicare, Medicaid HMOs, Worker’s Compensation/No Fault).
- Serves as a liaison for the interns, residents, and fellows by providing insurance guidelines, authorizations, and support for clinic patients requiring surgery.
- Reviews surgical procedures with doctor to make CPT and ICD coding recommendations.
- Utilizes HCPC codes to secure authorization for nutritional supplements, medications, or other items, deemed medically necessary for an effective recovery for the patient.
- Effectively communicates with patient registration desk, utilization management, nurses and medical director to give all pertinent clinical documentation as required to secure the surgical authorization.
- Tracks status of pending pre-certifications and pre-authorizations, keeping the providers informed of status. Maintains and updates notes on the Authorization Status Report for all team members to access information, as needed.
- Informs prospective surgery patients of insurance coverage and their financial responsibility. Utilizes surgical authorization form for patient to sign, reflecting insurance benefits, patient responsibility, and establishing payment plans as necessary.
- Creates medical record numbers (MRN), registering and maintaining all patient demographic, authorizations, and special directions in EPIC University Hospital system.
- Collaborates with co-surgeon’s specialist to ensure that multiple surgical procedures are effectively coordinated and authorized.
- Tracks surgical cases and manages the changes in surgery date by notifying the insurance company and all appropriate individuals.
- Responsible for maintaining excellent communication with surgery patients, including returning phone calls promptly and scheduling appointments. Documents communication per doctor’s request.
- Manages the appeal process when an authorization is denied by collaborating with the doctor, writing appeal and/or scheduling a peer-to peer review.
Home Location Campus: Newark (RBHS)
Five years of experience performing a full range of clerical support services that includes medical terminology preferred.
Required Knowledge, Skills, and Abilities:
Experience identifying and using ICD-10 and CPT codes.
Department: RSDM-Doc-Dental & Oral Health