Verification Specialist

Verification Specialist

CentraState Medical Center is currently seeking a Verification Specialist to support its Physical Therapy department. The role involves registering and scheduling patients in accordance with established procedures, pre-screening patients to determine accurate financial responsibilities, securing all legal consents and insurance information, verifying insurance coverage, and obtaining pre-certification authorization as appropriate.

Responsibilities

1. Uses critical thinking skills to verify each account in hospital registration system following all departmental procedures to ensure compliance with state and federal regulations, and industry standards.
2. Responsible to obtain and determine the coordination of benefits and accurately inputs into computer software system following industry standards and departmental procedure.
3. Clearly documents in computer system all communication with patients, family members, insurance companies and physicians. Documents any exceptions to standard procedure.
4. Is a strong decision maker in relation to completing quality checks and the review of each account for correct information.
5. Coordinates with insurance companies, patients, physicians, and/or employers to verify coverage, to notify of services and to obtain precert and/or referral requirements.
6. Coordinates discussions with physicians and physician's staff and patients on status of account and actions that will be taken. Clearly documents all communications.
7. Possesses communication skills, knowledge and professionalism to foster a discussion with patients and/or families on patient's financial responsibilities and clearly documents all communication.
8. Possess tertiary clinical knowledge to understand procedure/surgery/admission that is being verified.
9. Utilizes TRACE to record all outgoing verification calls to insurance companies.
10. Utilizes and trains staff on all available insurance company specific websites to ensure accurate and timely confirmation of coverage and on-line authorization where applicable and is responsible for maintaining security access.
11. Utilizes TRACE to retain all information from insurance website utilizing PIXCERT software.
12. Maximizes all available resources to accurately verify the account, including prior patient accounts, charity care list, Medicaid eligibility criteria, and Medicare Secondary Payor information. Clearly documents all findings and communications in registration and/or billing systems.
13. Investigates all self pay, workman compensation, no fault and secondary coverage utilizing birthday rule, patient vs spouse vs parents benefits, marital status, diagnosis, occurrence codes, cpt codes, employment status, age, dependency, physicians, families and employers. Clearly documents all findings and communications in registration and/or billing systems.
14. Accurately completes all forms required for a complete verification and sends to appropriate entity; Medicaid requirements to Self Pay Company, 21 day notices to No Fault Carriers, ABN to out patient departments.
15. Reverify denied accounts, review with supervisor for resolution. Resubmit or complete process for appeal.
16. Maintains productivity within guidelines set by department.

Qualifications

• High school diploma or equivalent required.
• Hospital experience in registration or billing preferred.
• Knowledge of medical terminology.
• Strong customer service skills.

About Us

CentraState Healthcare System, in partnership with Atlantic Health System, is a fully accredited, not-for-profit, community-based health system dedicated to providing comprehensive health services in central New Jersey. Beyond offering a wide range of advanced diagnostic and treatment options, CentraState is committed to being a valuable health partner, focusing on disease prevention, promoting healthy behaviors, and helping individuals of all ages live well.

Located in Freehold, CentraState includes a 284-bed acute-care hospital, a dynamic health and wellness campus, two award-winning senior living communities, a charitable foundation, and convenient satellite health pavilions. These pavilions offer primary care, specialty physician practices, and access to outpatient services such as lab work and physical therapy.

CentraState is proud to be among the less than two percent of hospitals nationwide to earn Magnet® designation for nursing excellence five times. Additionally, it has been recognized as a Great Place to Work-Certified™ Company by Great Place to Work® for four consecutive years.

Joining CentraState means becoming part of a pioneering healthcare facility committed to high-quality, patient-focused care. We invite you to make a difference in our community and advance your career with us. We support our employees with work/life balance initiatives, tuition assistance, career advancement opportunities, and more.

Discover why our employees love their jobs and being part of the CentraState family!

CentraState Health System offers a competitive and comprehensive Total Rewards package that supports the health, financial security, and well-being of all team members.

• Medical, Dental, Vision, Prescription Coverage (30 hours per week or above for full-time and part-time team members)
• Life & AD&D Insurance
• Long-Term Disability (with options to supplement)
• 403(b) Retirement Plan with employer match
• 401(a) Retirement Plan with employer contribution
• PTO
• Tuition Reimbursement
• Well-Being Rewards
• Employee Assistance Program (EAP)
• Fertility Coverage, Healthy Pregnancy Program
• Flexible Spending & Commuter Accounts
• Pet, Home & Auto, Identity Theft and Legal Insurance
• Growth Opportunity and Workforce Development Initiatives
• Continuing Education / Onsite Training
• A warm, welcoming company culture based upon mutual respect and a collaborative goal of providing excellent patient care
• Concierge Services with Work & Family Benefits
• Magnet recognized healthcare facility

Compensation Range: $18.00 - $28.80 per hour

The compensation above reflects the established range from CentraState Healthcare System (CSHS) for this position at the time the job was posted. CSHS considers many factors to determine compensation, including education, experience, skills, licenses, certification, and training. As such, team member compensation may fall outside this range.

Additionally, the compensation range reflects base salary and does not include extra shift rates or incentives tied to quality, productivity, etc., as applicable.

The benefits outlined also reflect CSHS' policy at the time of posting. Benefits as are made available to other similarly situated team members of CSHS, although participation is at all times in accordance with and subject to the eligibility and other provisions of such plans and programs. CSHS may modify its benefits plans or programs at any time.

CSHS is proud to comply with all pay equity and pay transparency laws.