Specialist, Mental Health-Adult OP

Req #: 0000203907

Category: Behavioral and Mental Health

Status: Full-Time

Shift: Day

Facility: Trinitas Regional Medical Center

Department: Mental Health-Adult OP

Salary: $20.97 - $26.50 per hour

Location:

NPC Plaza Building, 654 E. Jersey Street, Elizabeth, NJ 07206

Job Title: Specialist

Location: NPC PLAZA BLDG

Department Name: Mental Health-Adult OP

Req #: 0000203907

Status: Hourly

Shift: Day

Salary Range: $20.97 - $26.50, Hourly

Pay Transparency:

The above reflects the anticipated hourly range for this position if hired to work.

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 getting 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 equivalent
• At least 2 years of applicable experience

Preferred:

• B.A. or B.S. in Social Work, Psychology or Mental Health related
• Managed Care and Insurance experience
• Passport software experience

Scheduling Requirements:

• Full-time

Essential Functions:

• 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 database
• Responsible for tracking and managing case activity for the entire treatment process, insuring that all services are authorized, backing this up with related documentation
• Coordinates with clinicians and physicians to obtain clinical data for continuing case reviews; facilitates 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
• Provides verbal update on overall status of managed care caseload to program director/designee, as requested
• Provides information and referral services to patients, as requested
• Assists with telephone intakes, and setting up initial appointments, as assigned
• Assists with supporting and psychoeducational treatment service under the supervision of masters prepared staff
• Assists program director in identifying non-compliant clinicians and doctors
• Maintains query system in managed care database to allow for better tracking of expired auths or auths due to expire
• Enters insurance changes into system as needed
• Alerts Director or assistant director of non-compliant clinicians on a weekly basis
• Verifies 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 Insurance
• Dental and Vision Insurance
• Retirement Plans
• Short & Long Term Disability
• Life & Accidental Death Insurance
• Tuition Reimbursement
• Health Care/Dependent Care Flexible Spending Accounts
• Wellness Programs
• Voluntary 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

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