Verification Specialist

Verification Specialist

CentraState Medical Center has an employment opportunity available for a Verification Specialist. This position is responsible for registering and scheduling patients in line with established procedures. Key duties include pre-screening patients to determine financial responsibilities, securing legal consents and insurance details, assigning patient rooms based on criteria, verifying insurance coverage, coordinating with Outcomes Managers, and obtaining pre-certification authorizations as needed.

Responsibilities

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.

Strong decision maker in relation to completing quality checks and the review of each account for correct information including special needs and coordination of benefits. Seeks assistance and plans corrective action.

Held accountable for payment of account. Reverifies denied accounts, reviews with supervisor with suggestion resolution. Resubmits and initiates process for appeal.

Uses expert communication skills to coordinate discussions with insurance companies, patients, physicians, and/or employers to verify coverage, to notify of services, to obtain precert and/or referral requirements, and patient financial responsibilities. Clearly documents all communication.

Possess tertiary clinical knowledge to understand procedure/surgery/admission that is being verified.

Coordinates with the utilization review department of insurance changes and precert requirements. Clearly documents all findings and communications in registration and/or billing systems.

Responsible to check each account for special requirements to ensure payment (i.e.: inpatient only procedures, outpatient only procedures, authorized procedures).

Documents and communicates information to clinical OR Team.

Uses critical thinking skills to escalate issue to supervisor for further review and determination on how to proceed with complicated insurance issues regarding elective or emergent cases.

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.

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.

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.

Performs quality check on prior day accounts to ensure billing and charging accuracy.

Coordinates with self pay vendor and state agencies to ensure that appropriate screenings have been completed.

Coordinates and works with physician offices, OR scheduling department, and Radiology department to ensure accurate CPT coding for authorizations and maximum payment of contracted rates.

Possesses a high degree of competency in navigation of various software programs to obtain collateral for payment of accounts and future reference.

Qualifications

High school diploma or equivalent required.

Previous 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.

What We Offer:

• 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.