Surgical Representative

About the position

Rutgers, The State University of New Jersey, is seeking a Surgical Representative for the department of Medicine at the Robert Wood Johnson Medical School. This position serves as the primary staff liaison with all surgery patients from initial physician recommendation for surgery until surgery is completed. The Surgical Representative 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 HMO's, Commercial PPO's, Medicare, Medicaid HMO's, workers comp/no fault insurance carriers restrictions to assure all necessary criteria are met prior to surgery. Through this community of healers, scientists, and scholars, Rutgers is equipped as never before to transform lives.

Responsibilities

• Serves as a liaison for the OMFS 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.
• Verifies patient eligibility and benefits, and obtain pre-authorization, if required, for surgery.
• Utilizes HCPCs 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.

Requirements

• High school diploma or a GED required.
• Five (5) years of experience performing a full range of clerical support services that includes medical terminology required.
• Experience identifying and using ICD-10 and CPT codes.

Benefits

• Comprehensive benefit program to eligible employees.