Specialist Req #: 0000210873
Category: Behavioral and Mental Health
Status: Full-Time
Shift: Day
Facility: Trinitas Regional Medical Center
Department: OP Adult Partial Hospital
Pay Range: $20.97 - $26.50 per hour
Location: 654 E. Jersey Street, Elizabeth, NJ 07206

Job Title: Specialist

Location: NPC PLAZA BLDG

Department Name: OP Adult Partial Hospital

Req #: 0000210873

Status: Hourly

Shift: Day

Pay Range: $20.97 - $26.50 per hour

Pay Transparency:

The above reflects the anticipated hourly wage range for this position if hired to work in New Jersey.

The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience.

Job Overview:

As a Managed Care Specialist, you will be responsible for verifying benefits, securing prior authorizations and obtaining continued authorizations, scheduling and screening referrals in order to ensure consistent and timely response to the flow of referrals in consultation with clinicians and psychiatrists, as well as being responsible for maintaining accurate verification of all new and current patient's insurance information.

Qualifications:

Required:

HS Diploma or equivalentAt least 2 years of applicable experienceManaged Care and Insurance experience

Preferred:

B.A. or B.S. in Social Work, Psychology or Mental Health relatedPassport software experience

Scheduling Requirements:

Full-time 

Essential Functions:

Back-up support for registration and pre-intake functions as necessaryBack-up support/coverage for SWAs, as necessaryObtains appropriate release of informationContacts insurance companies to obtain current benefit information/eligibility for patients with insurance benefitsContacts managed care companies to obtain initial authorization/precertification servicesResponsible for documentation and data entry on all managed care/EAP cases, including information on payor status forms and timely entry into a computer databaseResponsible for tracking and managing case activity for the entire treatment process, insuring that all services are authorized, backing this up with related documentationCoordinates with clinicians and physicians to obtain clinical data for continuing case reviews; facilitates time completion and submission of forms to managed care companiesProvides statistics on managed care/commercial insurance cases on a regular basisPrepares out-of-network agreements for patients with special billing arrangements and tracks service activity utilizationAssists managing charity care caseload, as assignedProvides verbal update on overall status of managed care caseload to program director/designee, as requestedProvides information and referral services to patients, as requestedAssists with telephone intakes, and setting up initial appointments, as assignedAssists with supporting and psychoeducational treatment service under the supervision of masters prepared staffAssists program director in identifying non-compliant clinicians and doctorsMaintains query system in managed care database to allow for better tracking of expired auths or auths due to expireEnters insurance changes into system as neededAlerts Director or assistant director of non-compliant clinicians on a weekly basisVerifies insurance for incoming patients within 2 days

Benefits and Perks:

At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees’ physical, emotional, social, and financial health.

Paid Time Off (PTO)Medical and Prescription Drug InsuranceDental and Vision InsuranceRetirement PlansShort & Long Term DisabilityLife & Accidental Death InsuranceTuition ReimbursementHealth Care/Dependent Care Flexible Spending AccountsWellness ProgramsVoluntary Benefits (e.g., Pet Insurance)Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!

Choosing RWJBarnabas Health!

RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team.  We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time.  As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health. 

RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey—whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.

RWJBarnabas Health is an Equal Opportunity Employer